Achieving behavioral health care integration in rural America

Achieving behavioral health care integration in rural America

Collection:
Health Policy and Services Research
Contributor(s):
Bipartisan Policy Center, issuing body.
Publication:
Washington, DC : Bipartisan Policy Center, May 2023
Language(s):
English
Format:
Text
Subject(s):
Behavioral Medicine
Community Mental Health Services
Health Promotion -- legislation & jurisprudence
Health Services Accessibility
Rural Health Services
Social Determinants of Health
United States
Genre(s):
Technical Report
Abstract:
Integrating primary care services and treatment for mental health and substance use conditions not only enhances patients’ access to needed care but also improves health outcomes in a cost-effective way. Yet the barriers to integrated care are substantial, and it is even more difficult to achieve in rural and frontier communities, which are home to 1 in 7 Americans. This report builds on the Bipartisan Policy Center’s March 2021 Behavioral Health Integration Task Force report, which looked broadly at ways to achieve behavioral health and primary care integration across the United States. Primary care providers already handle some of the behavioral health care needs of their patients, but they describe feeling overwhelmed, ill-equipped to handle these tasks, and underpaid. To incentivize and enable primary care providers to take on a greater role in delivering mental health and substance use treatment services, they will need training, technical assistance, adequate reimbursement, and access to a larger pool of behavioral health providers for both consultations and referrals. Our current work focuses on breaking down the barriers to integration in rural America, where the health care infrastructure and provider composition vary in distinct ways from urban and suburban areas. Americans in rural areas face significant shortages of psychiatrists, psychologists, clinical social workers, and other behavioral health specialists. More than 60% of nonmetropolitan counties lack a psychiatrist, and almost half of nonmetropolitan counties do not have a psychologist, compared with 27% and 19% of urban counties, respectively. These gaps in specialty care force rural residents to rely heavily on primary providers for much of their care. Over the past year, BPC conducted a series of interviews with rural health policy experts, national organizations, federal and state leaders, providers, payers, consumers, and academics to gain insight into the opportunities and challenges related to delivering integrated care in rural areas. BPC’s recommendations provide a clear pathway to expand integrated primary care and behavioral health services in rural America, partially by leveraging the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) that dominate health care delivery - particularly primary care - in these communities. The centers are key to integration in rural areas, as primary care providers often serve as a gateway into behavioral health care. FQHCs experienced an 83% increase in patient visits for mental health and substance use disorder services between 2010 and 2016, outpacing the growth of medical visits and total visits. As such, RHCs and FQHCs are critical to providing not only primary care but also behavioral health care to the populations they serve BPC also takes a closer look at the needs of several populations that rely heavily on alternate delivery systems for much of their care in rural areas: veterans; American Indians and Alaska Natives (AI/AN); and individuals with high behavioral health needs, including those with serious mental illness and substance use disorders. The recommendations in this report would improve the ability of rural communities to better coordinate and integrate primary care and behavioral health services for these three high-risk groups. The policy recommendations, if implemented, would also expand the ability of primary care providers to handle the lower-acuity behavioral health needs of their patients by providing enhanced payments, training, and improved access to behavioral health providers for consultation and referral. BPC’s recommendations call for the expanded use of telehealth, which took off during the COVID-19 pandemic, and new investments to ensure the delivery of integrated care in rural America.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (57 pages)) : illustrations
Illustrations:
Illustrations
NLM Unique ID:
9918645388706676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918645388706676