Outlook: A Quarterly Newsletter of the Society of Behavorial Medicine
Fall 2009 Return to Outlook Main page »


William Sieber, PhD, Editor for Integrated Primary Care SIG

With the new administration in Washington and significant efforts focused on health care reform, Integrated Primary Care SIG members are more active than ever in helping shape health care by integrating behavioral medicine into primary care. While much remains to be worked out in Congress about the specifics, the emphasis placed on primary care and health promotion/disease prevention suggests SBM members will play a vital and growing role in U.S. health care. Some of our members' activities are summarized here.

Patient Centered Medical Home and Behavioral Medicine

Many efforts to transform primary care service delivery are occurring through the concept of the Patient Centered Medical Home (PCMH). The PCMH is a delivery model that holds great potential to produce better health care outcomes and control cost. The unprecedented focus on health care reform to include the PCMH has created the "perfect storm" to facilitate the integration of behavioral health and primary care in ways that have not been possible in the past. Among the core principles of the PCMH are that there be a whole person orientation and that care be coordinated and/or integrated.

Legislative actions related to PCMH include House and Senate committees calling for payment increases for primary care services and that make provisions for the PCMH. The House, the Ways and Means Committee, the Energy and Commerce Committee, and the Education and Labor Committee introduced a bill that provides $350 million for Medicare PCMH pilot projects, and the Senate Health, Education, Labor and Pensions (HELP) Committee has introduced legislation authorizing grants for new education and training programs in medical schools and residency programs that support the PCMH.

IPC SIG members, such as Christopher Hunter, PhD (SIG chair), are involved in organizations and task forces that facilitate the development and implementation of the PCMH. The Patient-Centered Primary Care Collaborative (PCPCC; http://www.pcpcc.net) is "an open forum where health care stakeholders freely communicate and work together to improve the future of the American medical system." The collaborative hosts an annual summit and provides multiple resources for individuals interested in PCMH. The PCPCC formed a Behavioral Health Task Force, which includes behavioral health subject matter experts from across the country who have created a set of behavioral health in primary care talking points for the PCPCC. These talking points delineate the range of options for integrated-collaborative behavioral health in the PCMH.

The IPC SIG has worked to contribute to the policies related to the PCMH and to support practitioners and research within the PCMH. In October 2008 the IPC developed a policy paper that was distributed to the Obama administration highlighting the need for integrated care (See Outlook, fall 2008). IPC SIG members have conducted workshops at SBM annual conventions teaching practitioners skills for working in an integrated setting, and collaborate with other organizations such as the Collaborative Family Healthcare Association to inform providers about the most effective methods for delivering care in an integrated setting. Practitioners and researchers working in primary care environments will need to consider how they fit into the PCMH as this will likely be a guiding force in primary care for many years.

The Collaborative Care Research Network (CCRN)

Ben Miller, PsyD; Rodger Kessler, PhD, ABPP and others are leading efforts in creating a sub-network of the American Academy of Family Physicians National Research Network. The Collaborative Care Research Network (CCRN) was created to develop and implement a national, practice-based research agenda to evaluate the effectiveness of collaboration between mental health and primary medical care. With the emergence of the patient-centered medical home concept and demonstrations, it is clear that such services are to be a prominent dimension of responding to patient and families' health needs. A patient centered medical home without mental health fails. However, there is an equally crucial need to evaluate the effectiveness of such collaborative care in ways that are both useful to primary care practitioners, and answer the important questions that have and will be raised. The recent Agency for Healthcare Research and Quality (AHRQ) systematic review concluded that integrated and collaborative care was generally effective but that currently there was no evidence to support that any particular models were superior, or that we can identify specific elements that account for effectiveness. They conclude with a call for effectiveness research to respond to these issues. The CCRN is a first step in answering this call. For information or to enroll, visit: www.aafp.org/nrn/ccrn