“I have been dealing with mental health issues a long time, but I wasn’t comfortable before. Here they seem genuinely concerned about my well-being.”—Donna, 54, patient, the Bronx
NEW YORK, NEW YORK April 4, 2019—One in five New Yorkers suffer from mental health disorders, but most of these people do not have access to treatment, especially in disadvantaged communities. A year-long project demonstrated that small primary care practices can help fill this gap by screening patients for depression and coordinating their mental health, medical, and social service needs, according to a report released today by United Hospital Fund, Montefiore Health System, and the New York State Health Foundation (NYSHealth).
A team led by Henry Chung, MD, of Montefiore and Harold Pincus, MD, of New York-Presbyterian Hospital developed a framework, with support from UHF, for primary care practices to integrate behavioral health screening and treatment into how they deliver care.
With additional support from NYSHealth and UHF, Drs. Chung and Pincus conducted an evaluation in 2018 of 11 medical practices across New York State using the framework, all at locations with less than five primary care providers. Among a representative sample of practices, depression screening rates improved from a baseline of 25 percent to 33 percent, and depression detection rates increased by 78 percent. There were also improvements in referrals, tracking patients, and greater information-sharing between primary care doctors and behavioral health specialists.
The results, reported in Evaluation of a Continuum-Based Behavioral Health Integration Framework Among Small Primary Care Practices in New York State, demonstrate that the framework is an effective tool for helping small primary care practices better respond to patients’ behavioral and physical health needs.
“I had just lost my job and was coping with thyroid cancer, but above all I was most worried about being able to pay my son’s college tuition. Everything was just coming down on me. I was screened during a regular visit at the office and I guess I was feeling so bad emotionally that the doctor saw that I needed therapy…I’m feeling a lot better, now, it’s helped a lot, and I’m taking better care of my health now too as a result. I’ve become a vegan!”—Jazmine, 41, patient, Community Healthcare Network, the Bronx
Small primary care practices are often a patient’s main touch point with the health care system. However, these practices can lack trained staff and resources to properly screen and treat people with depression and other mental health disorders.
Reimbursement for treatment in primary care can also be a problem. The framework stresses the importance of payment reform to ensure primary care practices are adequately reimbursed for expanded behavioral health services. Revenues increased as practices began to bill for mental health screening.
“The majority of people with behavioral health needs are often undiagnosed, undertreated and fall through system cracks,” said Dr. Chung, project director and senior medical director of behavioral health integration strategy at Montefiore’s care management organization. “We’re showing that primary care practices can fill those cracks and help people get the help they need.
"People tell me all the time that it’s very hard for primary care and psychiatric care to get on the same page, but that’s not true anymore…We started at just one clinic, and now we have the resources, framework and guidance to provide the very best care across our network.”—Dr. Joseph Squitieri, Community Healthcare Network
“Making behavioral health care available in primary care settings is crucial to improving the health of all New Yorkers,” said David Sandman, Ph.D., President and CEO of NYSHealth. “Integrating medical, mental health, and social services can help small primary care practices better meet the needs of their patients. We hope to see more collaboration among funders and practices alike in addressing this service gap.”
“This groundbreaking initiative is another example of the value of collaboration in improving the health of New Yorkers,” said Anthony Shih, MD, MPH, president of UHF. “We hope this report will inspire additional primary care practices to begin the process of integrating behavioral health services, and funders to support efforts to improve health care access and quality in innovative, effective ways.”
In addition to Dr. Chung, the report was co-authored by Ekaterina Smali, MPH, MPA, PMP, at Montefiore; Matthew L. Goldman, MD, MS, formerly at Columbia University; and Dr. Pincus, professor and vice chair of the Department of Psychiatry, and co-director of the Irving Institute for Clinical and Translational Research, Columbia University.
The report can be downloaded at UHF’s website here.
About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs, please visit our website at www.uhfnyc.org and follow us on Twitter.
About Montefiore Health System
Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 11 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.
About New York State Health Foundation
The New York State Health Foundation (NYSHealth) is a private, statewide foundation dedicated to improving the health of all New Yorkers, especially the most vulnerable. Today, NYSHealth concentrates its work in two strategic priority areas: building healthy communities and empowering health care consumers. The Foundation is committed to making grants, informing health policy and practice, spreading effective programs to improve the health care system and the health of New Yorkers, serving as a neutral convener of health leaders across the State, and providing technical assistance to its grantees and partners.