Managing population health: integrating behavioral health and primary care

I just read through an interesting policy brief from RWJF on integrating behavioral health and primary care:

Druss BG, Walker ER.  Mental Disorders and Medical Comorbidity  Research Synthesis Report No. 21 Robert Wood Johnson Foundation

Their review of the literature supports the shift from disease to person/population health management that I've described in the past.

• Many people with chronic conditions have co-morbid mental and behavioral health issues
• These individuals suffer worse outcomes and drive a disproportionate share of health expenditures
• The co-morbid conditions are more than additive in impact
  • The presence of either increases the probability of the other
  • Mental health disorders dramatically increase the probability of high-risk lifestyle issues (e.g. smoking, obesity, lack of exercise)
• “'Collaborative care' approaches that use a multidisciplinary team to screen and track mental conditions in primary care settings have been the most effective in treating these conditions"

More effective total population health can be achieved by:

• Screening all using a behaviorally sophisticated tool like HowsYourHealth
• Integrating behavioral health in primary care
  • Brief input on diagnosis and treatment plans
  • Brief intervention
  • Facilitated referral
  • Case management for individuals, not just conditions

Success requires moving from disease to population.  Early strategic choices by nascent ACOs could either tie up scarce resources in disease, running the risk of inadequate impact on total population outcomes.