This assessment evaluates the evidence on the clinical effectiveness and value of the integration of behavioral health services into primary care settings and reviews barriers and potential policy options for the implementation of such integrated care in the US generally and in selected states. It informed two recent meetings of the California Technology Assessment Forum (CTAF) and New England Comparative Effectiveness Public Advisory Council (CEPAC), which are core programs of the Institute for Clinical and Economic Review (ICER). Background. Providers in the US health care system often assess and treat patients with physical health conditions and behavioral health conditions (e.g., mental health and substance use disorders) in siloes, yet physical and behavioral health are inextricably linked. Up to 70% of physician visits are for issues with a behavioral health component. A similar proportion of adults with behavioral health conditions have one or more physical health issues. Having a chronic condition is a risk factor for having a behavioral health condition and vice versa. Depression and anxiety in particular are common in primary care settings but are often inadequately identified and treated, leading to a worsening of behavioral conditions and/or increased difficulty managing physical health conditions. Behavioral health integration (BHI) into primary care addresses both physical and behavioral health needs in primary care settings through systematic coordination and collaboration among health care providers. While behavioral health can be defined quite broadly, for the clinical effectiveness analysis in this report, we limited our scope to two mental health conditions that are frequently diagnosed and managed in primary care settings (i.e., anxiety and depression). During the past two decades, many initiatives have sought to integrate behavioral health and primary care. The overall goals of BHI are those of the Triple Aim--better outcomes, better care experience, and reduced costs. How these goals are achieved and the terms used to describe various aspects of integrated care vary extensively. Decision-makers across the health care spectrum recognize the need to better serve patients with behavioral health conditions, but questions remain regarding the latest evidence on the effectiveness and value of BHI, as well as how best to approach implementation and which aspects of integration are most important for improved patient outcomes. This report supported CTAF and CEPAC's deliberations and attempts to answer some of the key issues related to BHI confronting patients, provider organizations, payers, and other policymakers. The goals of this report are to: 1) evaluate the evidence on the comparative clinical effectiveness and value of efforts to integrate behavioral health into primary care, 2) identify the models and components potentially associated with successful integration and outcomes, 3) assess the potential budget impact of integrating behavioral health into primary care, and 4) provide an overview of barriers to integration and lessons learned from national and state-based experts to help identify potential innovations and solutions for BHI. Conceptual Framework. For this report, we reviewed the Agency for Healthcare Research and Quality (AHRQ) lexicon and a framework published in 2013 by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration (SAMHSA-HRSA) Center for Integrated Health Solutions (CIHS). These two resources define terms, structures, and competencies used in BHI efforts.
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1 online resource (1 PDF file (ES1-ES10, 141 pages))