Behavioral Health and the Medical Home Model

In a session delivered at the AACAP 57th Annual Meeting, Kyu Rhee, MD, chief public health officer at Health Resources and Services Administration (HRSA), discussed the organization’s efforts to improve behavioral health for underserved populations by establishing a new model of care.

The goal of the HRSA, he said, is to help drive better health outcomes through better access to quality care, and to build a more skilled health workforce. At the center of HRSA’s vision is the patient-centered medical home, a model designed to provide “comprehensive primary care” to patients by facilitating the coordination of care delivered by different specialists.

“It’s critical that all of those providers are working together,” said Rhee, adding that behavioral health should be a core piece of the puzzle, particularly as depression prevalence continues to increase in the US. “Mental and physical health problems are interwoven.”

HRSA, he noted, is focused on integrated substance abuse services into primary care using performance measures, and incorporated more behavioral care into the primary care setting. This can most effectively be done utilizing an integrated care model in which primary care physicians and mental health providers—whether they work in the same office or separate facilities—collaborate to develop one treatment plan for conditions such as obesity and sleep problems that impact both physical and mental health.

Another key focus of HRSA is to link personal and population health, said Rhee. “The idea is that in treating one patient, you focus on the entire community.” A number of studies have shown that significant disparities in care exist among patients in different socioeconomic groups; patients in low-income settings are not likely to seek care for symptoms until they have developed a chronic disease. Therefore, it is critical that health care provides address the needs of the entire patient community, and to consider the broader determinants of health—factors such as employment, housing, and environmental conditions, in diagnosing and treating patients.

The challenge, he noted, is that primary care physicians often have only 15 minutes with each patient—a challenge that is compounded in patients who don’t seek regular care, those who can’t afford medications, and those facing language barriers.

“We need to think outside of our exam walls” and find a way to link personal and population health, said Rhee, who urges all health care providers to stay educated on the changes brought on by health care reform, and to act as an advocate. “We want policy to be driven by practitioners who are out there in the trenches.”

Rhee believes that the Affordable Care Act (ACA) can open several doors for organizations like HRSA by increasing access to primary care. As part of the Act, $11 billion is being allocated to expand community health centers, and to incorporate programs that include case managers, outreach workers, interpretation staff, eligibility workers, and other behavioral health services.

ACA is also investing significant dollars in building the health care workforce, providing support for maternal and child health, and broadening access to 340B drug pricing.

“Access to medication at an affordable cost is one of the biggest barriers to care, especially in underserved areas,” said Rhee. The ACA offers “many opportunities to advance behavioral health,” he added, noting that it is vital that all health care providers take an active role in “transforming and improving our health system.”