Person-based, holistic care: Challenges, opportunities, facilitators and funding for integrating recovery-oriented behavioral and primary care practices

Research studies indicate that individuals at risk for mental health and substance use conditions, and ripe for prevention, assessment and early intervention often appear for health services first in pediatric and adult primary care settings. The evidence points to gaps in health practitioners' knowledge and performance in addressing behavioral health conditions. However, when effective interventions are appropriately applied, reductions are achieved in medical costs and related social and economic burden for individuals and families. With expansion of eligibility for Medicaid and subsidized insurance exchange coverage, many individuals in high risk groups or with behavioral health conditions will have improved access to primary care. Given current projections on the significant shortages of primary care practitioners, increased demand will exacerbate pressures on practitioners to practice as efficiently as possible, while value based purchasing goals will add pressures to ensure results. In efforts to address prevention and treatment for behavioral health conditions, primary care practitioners face additional hurdles associated with the historical separation of behavioral health into specialty care – lack of expertise and clinical pathways to address these conditions and poorly articulated and inconsistent reimbursement structures to sustain screening, intervention and support practices. This drive for integration occurs in an era of consumer-directed care and recovery-oriented care, notions now widely accepted in the behavioral health field, but less familiar to those in the primary care sector. Effective integrated care practices support primary care practitioners to timely address prevention, treatment and recovery support for persons at risk for or with behavioral health conditions.