The Dawn of Integrated Care for Psychophysiologic Disorders (PPD)

A paper published in 2014 (1) is getting a lot of attention now because of the following conclusions (italics mine):

Medical costs for treating those patients with chronic medical and comorbid mental health/substance use disorder (MH/SUD) conditions can be 2-3 times as high as those beneficiaries who don‘t have the comorbid MH/SUD conditions. The additional healthcare costs incurred by people with behavioral comorbidities are estimated to be $293 billion in 2012 across commercially-insured, Medicaid, and Medicare beneficiaries in the United States. Most of the increased cost for those with comorbid MH/SUD conditions is attributed to medical services (more than behavioral), creating a large opportunity for savings on the medical side through integration of behavioral and medical services. Based on our literature review on the results of effective IMBH (Integrated Medical and Behavioral Health) programs, we calculate that 9-16% of this total additional spending may be saved through effective integration of care, although additional work and direct experience will be needed in this area.

This savings ($26-$48 billion) is comparable to the total U.S. annual expenditure for physicians providing mental health or substance abuse treatment.  Consequently, the paper is generating conversations about placing Behavioral Health Clinicians (BHC) in medical offices.  That this is an ideal model for managing Psychophysiologic Disorders (PPD) is supported by a recent consensus report (2).  The report listed core competencies for BHCs, including “Behavioral Health or psychosocial contributors to common physical health problems such as chronic illnesses and medically unexplained or stress-related physical symptoms.”

To support that competence, I have written an introduction to PPD (3) that was published in December 2016 by the Collaborative Family Healthcare Association (CFHA) in their journal Families, Systems and Health.  A PDF of the article is already available for about $12 by clicking here.  The CFHA mission includes promoting “models of healthcare delivery that integrate mind and body.”

I deferred writing this paper for many years because there was little published evidence supporting the approach to PPD that I (and many others) learned by experience.  There was also no compelling financial incentive for clinicians to change the way they practice.  But in the last several years both of those conditions have changed significantly for the better.  I was able to find nearly fifty references that provide a scientific foundation for my approach to PPD patients.  We might well be at a tipping point for improved care of this condition.

  1. Melek, S., Norris, S. T., and Paulus, J., “Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry,” prepared for the American Psychiatric Association by Milliman, Inc., April 2014.
  2. Benjamin F. Miller, PsyD, Emma C. Gilchrist, MPH, Kaile M. Ross, MA, Shale L. Wong, MD, MSPH, Alexander Blount, EdD, C.J. Peek, PhD. Core Competencies for Behavioral Health Providers Working in Primary Care. Prepared from the Colorado Consensus Conference. February 2016.
  3. Clarke DD. (2016). Diagnosis and Treatment of Medically Unexplained Symptoms and Chronic Functional Syndromes.  Families, Systems, & Health, Vol 34(4), Dec 2016, 309-316.

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