Direct primary care-Where does integrated behavioral health fit?

Primary care is increasingly viewed as key to growing health system market share in value-based purchasing strategies for both public- and private-sector programs. Yet not all primary care physicians are interested in becoming part of large multispecialty practices or working in employed arrangements. Instead, a growing number of physicians are launching independent direct primary care (DPC) practices in order to maintain professional autonomy, mitigate burnout, and ensure long-term meaningful engagement with patients and families. Given that the typical size of a DPC care team is small, what does this mean for integrating behavioral health? As primary care evolves under various payment and delivery models, the integration of behavioral health services will require adaptability based on practice size, scope of practice, patient acuity, and payment model. Indeed, advocates of integrated behavioral health can "skate to where the puck is going to be"1 by familiarizing themselves with innovations in primary care, such as the DPC model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Who is driving change, and where is it taking us? Interview with an expert.

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Promoting health payment reform literacy: Does integrated care save money?

INTRODUCTION: Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care. METHOD: This paper offers a primer on the current state of health care spending in the United States, an overview of public and private payers, and the challenges each faces in paying for integrated care. DISCUSSION: Future journal articles in the FSH Policy and Management Department will describe key payment policy and management opportunities for integrated care payment reform. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Addressing Rural Health Challenges Head On.

Providing health care to patients and families living in rural America presents significant challenges, but comes with unique rewards. The physician who chooses a rural life typically cares for an underserved and aging population, which is often less healthy and affluent than its urban and suburban counterparts. At the same time, rural clinicians feel deeply connected to their patients and their communities. Physicians cite strong doctor-patient relationships as a primary motivator to practice in a rural setting, in addition to lower cost of living and slower pace of life1. Those who choose primary care specialties also enjoy the challenge of caring for multiple, interrelated aspects of health for their patients and community. During Kansas City University of Medicine and Biosciences' (KCU) century-long history, we have offered our osteopathic medical students the opportunity to learn in rural areas during the third and fourth years. As our new, state-of-the-art medical school campus opens in Joplin, Missouri, we will build on our commitment to rural health by offering first- and second-year KCU-Joplin students training opportunities in rural settings, and expanding third- and fourth-year rural clinical rotations. The rich experience to learn rural medicine offers the potential to connect medical students, patients and community in new and exciting ways, building on the firm foundation of osteopathic medical training grounded in strong patient-centered primary care.