NYHealth Hosts “Behavioral Health and Delivery System Reform: A Conversation with Harold Pincus”

People with behavioral health conditions, such as mental illness and substance use disorders, experience chronic illness and premature mortality at much higher rates than people without behavioral health conditions. Some reasons for this disparity include economic disadvantages, unhealthy lifestyles, and the side effects of medication; however, the fragmentation of our health care system also contributes to disparities in access to services and the quality of medical care for people with behavioral health issues. In New York State, providers and plans are undertaking a variety of strategies to overcome this fragmentation. Furthermore, one pillar of the New York State Health Innovation Plan focuses on integrating care to meet consumer needs seamlessly.

In his presentation, Dr. Pincus explained that change must happen at the clinical, organizational, and policy levels. “We have excellent documentation and a wide selection of effective integrated care models, but we still have structural and financial barriers and disincentives that limit their implementation in a fee-for-service world,” said Dr. Pincus. At the clinical level, physicians and other caregivers will require additional training to work within new structures that encourage care coordination. Programs and organizations will need to change their cultures and processes to promote coordination, and set expectations to measure clinicians’ performance. Dr. Pincus called this culture change the biggest challenge of all, given that there have been “centuries of separation” between physical and behavioral health care entities. “You could have a unified organization with very separate walled-off silos within it,” said Dr. Pincus. He recommended that organizations implement shared accountability, where primary and behavioral health care providers are jointly responsible for ensuring quality in both physical and behavioral health care for individual patients. Policymakers and purchasers—working with input from patient care providers—also need to establish corresponding measures to evaluate accountability and coordination. Additional recommendations for policymakers include integrating program evaluation from the outset; increasing flexibility by adapting facility regulations and privacy regulations that are often duplicative or prohibitively complex; and improving access to and coordination between state data registries and databases.

Dr. Pincus highlighted how people are affected by the need for delivery system reform. For example, patients with depression have higher total health care costs, even after adjusting for costs connected to comorbid medical conditions. He explained that many psychiatrists do not accept health insurance, and this is a real barrier for patients in dire need of mental health care. Untreated depression makes it difficult to improve patients’ physical health. Dr. Pincus noted that the profession of psychiatry could help by promoting a sense of public service and requiring ongoing certification that includes quality and outcome assessments. Dr. Pincus also stated that insurers need to change payment structures to recognize the integration of the health care field.

Attendees at the event included representatives from behavioral health and primary care systems; representatives of health care plans; providers; researchers; New York City and State government officials; and funders. Discussion with the audience underlined that it will be necessary to have a multi-sector approach to get high-need individuals into integrated care settings and create system reform that will create incentives and allow collaboration among providers.