Health-care reform is encouraging hospitals and health systems to integrate mental and behavioral health care into primary care,
said speakers at the State Leadership Conference. From left to right: Dr. Frank V. deGruy, of the University of Colorado School of
Medicine, Dr. Robin Henderson, of the Central Oregon Health Council, Rebecca B. Chickey, of the American Hospital Association,
and Dr. Elizabeth Winkelman, of APA’s Practice Directorate.
Health Council. The council oversees Oregon’s coordinated care
organization, which develops initiatives demonstrating that
integrating physical and behavioral health care can improve
health outcomes and lower Medicaid costs.
“How are we going to get paid in the future?” Henderson
asked. “For the outcomes we produce.” The coordinated care
organization receives a lump sum for all the care it provides to
Medicaid patients, then shares in any savings it achieves.
The coordinated care organization has launched several
transformation initiatives, all of which involve psychologists
providing behavioral interventions to people with medical
conditions. In the obstetrics department, psychologists help
women comply with pre-term regimens, overcome addiction
and cope with postpartum depression, for example. In the
neonatal intensive care unit — “the most expensive place in any
hospital,” said Henderson — psychologists have helped reduce
lengths of stay by working with families. Psychologists have also
worked with pediatric asthma patients, teaching better asthma
control behaviors as a way of keeping patients out of costly
Many initiatives target the 12 percent of individuals
responsible for 82 percent of costs, who typically have chronic
diseases. But embedding psychologists in primary care can
also help with prevention, said Henderson, explaining that the
health-care system needs to get better at identifying people on
their way to developing chronic conditions.
The coordinated care organization is also doing things
the other way around, by putting primary-care clinicians
into clinics for people with serious mental illness. Henderson
predicts that in 15 or 20 years, such clinics won’t even exist.
Instead, people with severe mental illness will receive treatment
in primary-care settings. “That will be the new normal,” she