Two recent reports provide insight into the state of integrated care. Here we summarize their findings so you don’t have to do all the reading! The Year 4 evaluation of the CMS alternative payment model, CPC+, describes the outcomes of integrated behavioral health in the demonstration project and notes challenges to sustainability. The Graham Center report offers current statistics and insights from the Family Medicine perspective including statements of support for integrated care.
The Centers for Medicare and Medicaid Services (CMS) released the 4th Annual Independent Evaluation of Comprehensive Primary Care Plus (CPC+)1. Over 2,900 primary care practices participated in this public-private alternative payment model which began in 2017 and was designed to improve access to and the quality of primary care. CPC+ provided additional funding to support access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health. Behavioral health was a requirement under the comprehensiveness goal of meeting most patients’ needs in primary care.
The report states that by Program Year 4 (2020):
- 99% of practices had a strategy to address behavioral health needs
- 57% of practices selected the Primary Care Behaviorist model, 36% Collaborative Care Management model and 5% used a combination of the two
- Practices with onsite behaviorists increase from 25% in 2017 to 57% in 2020
- CPC+ beneficiaries showed a reduction in long term opioid use and potential overuse between 2016 and 2020
Funding for CPC+ pilot program ended in December of 2021 and the final report is pending. PY4 reports practices value behavioral health integration for increasing patient’s access to and engagement in behavioral health services, improving communication and collaboration between behavioral health and primary care providers, and enabling primary care providers to focus on other aspects of care. Practices noted that without the additional APM funding, they were unsure of whether innovations would be sustainable.
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care released the “STATE OF INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH IN THE UNITED STATES”2. It offers data on the incidence of behavioral health concerns and the increase due to the pandemic and the lack of available treatment attributed to workforce shortage and other barriers. The report makes the case for integrated primary care as an intervention to better manage chronic health conditions and substance use disorders and highlights the estimated increase in cost of care due to untreated behavioral health needs.
Additional sections summarize definitions of integrated care from the Agency for Health Research and Quality (AHRQ), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Milbank Memorial Fund. The report lists the known common barriers to integration including payment and workforce issues and details 4 case studies of integrated care. The report concludes with the following statements of support for integrated care:
“Integrated primary and behavioral health care is effective and evidence-based.
Integrated care will improve access.
Integrated care supports health equity.”2
- Comprehensive Primary Care Plus (CPC+) Model: Evaluation of the Fourth Year (2020). https://innovation.cms.gov/innovation-models/comprehensive-primary-care-plus
- Westfall JM, Jabbarpour Y, Jetty, A, Kuwahara R, Olaisen H, Byun H, Kamerow D, Guerriero M, McGehee T, Carrozza M, Topmiller M, Grandmont J. Rankin J. The State of Integrated Primary Care and Behavioral Health in the United States 2022. Robert Graham Center, HealthLandscape. May 31, 2022. https://www.graham-center.org/home.html https://healthlandscape.org/