ICER Report Presents Evidence-based Guidance to Support Integration of Behavioral Health into Primary Care

Boston, Mass., June 2, 2015 – The Institute for Clinical and Economic Review (ICER) has posted the final report Integrating Behavioral Health into Primary Care and its accompanying action guides and policy brief to the CTAF and CEPAC websites. The report evaluates the evidence on the comparative clinical effectiveness and value of efforts to integrate behavioral health into primary care settings as well as providing guidance on how to apply that evidence in the real world.

Effective behavioral health integration (BHI) can be accomplished through different care delivery models, and in practice, implementation will be tailored to distinct patient populations and other local considerations. The approach to integration with the strongest evidence base is the collaborative care model (CCM), but practices implementing BHI should use available resources and seek guidance from organizations that have experience with the CCM and other models while accounting for differences in population, resources, treatment priorities, and funding.

The final report released today draws on two draft reports that served as the basis for deliberation and discussion at recent meetings of two independent groups that review and discuss evidence: the California Technology Assessment Forum (CTAF) and the New England Comparative Effectiveness Public Advisory Council (CEPAC). The report includes a summary of votes from each group, along with key recommendations based on the groups’ discussions with a policy roundtable of experts during each meeting.

Both groups voted unanimously that the evidence shows CCM improves health outcomes related to depression and anxiety, as well as patient satisfaction, when compared to usual care. Both groups judged the CCM to represent a reasonable to high care value, a rating that accounts for clinical effectiveness, incremental costs per outcome achieved, additional benefits of the intervention, and contextual considerations. For models of integration other than the CCM, both groups judged that there is insufficient evidence to determine the models’ effects on key outcomes, but emphasized that the votes indicate the need for more research, not that other models fail to provide benefit.

“On the front lines of providing quality primary care there is considerable interest and activity on integrating behavioral health. However, there is also a great deal of uncertainty on how to proceed.” said Steven Pearson, MD, President of ICER. “This final report provides guidance on how to move forward with integration based both on the available quantitative evidence and the qualitative recommendations of topic experts.”

Other recommendations pointed to a need for increased research on methods of integration other than the CCM, many of which anecdotally appear to be effective but have not yet undergone formal evaluation, as well as a need for value-based reimbursement models that fully support integration. A detailed description of the policy recommendations is available in the final report.

While CTAF and CEPAC evaluated separate draft reports, each tailored to the specific policy landscape of the regions where the meetings took place, the groups identified key recommendations that are applicable to both areas, despite local variations in policy.

ICER also released two companion documents to further distill and operationalize the report’s findings: a policy brief, which summarizes the key recommendations of the report for policymakers, and action guides that provide resources for policymakers, clinicians, and payers to support implementation of the recommendations. Distinct action guides are available for the New England region and for California, each with key national and region-specific resources, including state efforts to support integration, information about billing and payment practices, and resources to help clinicians educate their patients as integration is implemented. The policy brief and action guides are available on the CTAF and CEPAC websites.