CHICAGO — Physician organizations are working to accelerate the integration of behavioral health services into primary care settings and close the unmet need for mental health services and substance use disorder treatment, but physicians cannot solve the crisis on their own. A new call-to-action from eight of the nation’s leading physician organizations urges a unified and collective effort by stakeholders across the health care system to support equitable, whole-person care for patients and their families.

“Even with a clear recognition that our primary care systems must urgently embrace a paradigm shift to stem the growing behavioral health crisis, there remain significant challenges in building clinical pathways that provide whole person care,” said AMA Immediate Past President Gerald E. Hamon, M.D., co-author of the call-to-action. “These challenges cannot be overcome by physicians alone, and we are calling on payers and policymakers, among other industry stakeholders, to rally around a set of key solutions in partnership with physicians.”

The call-to-action, published today in Health Affairs, urges payers and policy makers to join forces with physicians and “act now to implement solutions and ensure primary care physicians and their care teams have the support to provide equitable, whole-person care for their patients and families.”

For employers, health plans and other payers in the health care system, the call-to-action outlines five solutions to accelerate widespread adoption of behavioral health integration (BHI) by primary care practices:

1. Expand coverage and fair payment for all stakeholders utilizing BHI models;
2. Evaluate how and when to apply cost-sharing for integrated services (whether delivered in person or via telehealth);
3. Assist primary care practices by offering technical support, provider training and regional sharing of resources;
4. Minimize and/or eliminate utilization management practices for BHI services; and
5. Launch whole-person, employer-based behavioral health programs with intentional culture-focused work to destigmatize behavioral health.

Federal and state policymakers can also support widespread adoption of BHI by primary care practices and the call-to-action outlines four critical steps:

1. Provide long-term sustainable funding opportunities for training and education on implementing BHI services;
2. Raise payment levels for BHI services for all stakeholders in federal and state coverage programs;
3. Work with health plans and coverage programs to limit utilization management review practices, enforce behavioral health parity laws, and strengthen network adequacy regulations; and
4. Increase federal funding with the aim of growing the behavioral health workforce especially for those who practice in underserved areas.

Physician organizations are committed to accessible and equitable treatment for behavioral, mental and physical health needs, and in 2020 established the BHI Collaborative incorporating the collective expertise of the American Academy of Child & Adolescent Psychiatry, American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Medical Association, American Osteopathic Association, and American Psychiatric Association.

The work of the BHI Collaborative helps physicians navigate and succeed in a continually evolving health care environment with proven resources for implementing a holistic approach to physical, mental and behavioral health that meet the critical needs of all patients.

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Quotes from Physician Organizations Represented in the BHI Collaborative:

Warren Y. K. Ng, M.D., M.P.H., President, American Academy of Child & Adolescent Psychiatry
"AACAP strongly supports collaborative relationships between child and adolescent psychiatrists and pediatricians in support of increasing urgently needed access to mental health screening and services for our nation's youth. We are pleased to partner with the other members of the BHI Collaborative to provide awareness, resources, and education on the potential of these models to address the current gaps in our mental health care delivery system."

Mark Del Monte, J.D., Chief Executive Officer, American Academy of Pediatrics
“The AAP is honored to join our colleagues in medicine coming together from across specialties to elevate the importance of behavioral and mental health integration at such a critical moment. Pediatricians have observed and raised alarm about the mental health crisis confronting children and adolescents well before the pandemic, and we are now facing a pivotal moment where urgent action is needed in and outside of pediatric offices to help confront it. It is our hope that this publication garners interest and commitment from other partners across the healthcare ecosystem, particularly payers and policymakers, to work with the physician community to make needed changes.”

Sterling N. Ransone Jr., M.D., President, American Academy of Family Physicians
“The AAFP has joined our colleagues across the medical community advocating for behavioral health integration for one simple reason: it’s the right thing to do. The COVID-19 pandemic has exacerbated an already-present mental health crisis in our country, and our patients deserve primary care that sees the whole person. Enhanced mental health screening and coordination of physical and behavioral health care services will serve our patients best. The BHI Collaborative is committed to realizing behavioral health integration throughout primary care practices, but we need policymakers, payers and industry stakeholders to join us in addressing the barriers to widespread, holistic care.”

Iffath Abbasi Hoskins, M.D., President, American College of Obstetricians and Gynecologists
"Mental and behavioral health issues are a leading, underlying cause of preventable pregnancy-related deaths. The COVID-19 pandemic has illuminated how integral mental health care is to our daily lives—and how harmful neglecting mental health care can be. Integrating mental health care into obstetric care is a vital step toward ensuring that patients receive holistic support and can access the treatment that they need."

Saul Levin, M.D., M.P.A., Chief Executive Officer and Medical Director, American Psychiatric Association
“This is an important statement from many leading physicians’ groups because together we know that integrated care, including collaborative care, will help millions of Americans access the mental health services they need. As we face the long-term mental health impacts of the pandemic, I’m pleased Health Affairs published this essay for their audience of key stakeholders, who can help as physicians implement these innovative solutions.”