The patient-centered medical home (PCMH) is at the hub of transformative changes to address the triple aim of reducing health care costs, improving the patient experience, and bettering population health. In May 2013, the PCMH research conference, sponsored by the Agency for Healthcare Research and Quality, the Veterans Health Administration, and the US Department of Veterans Affairs, brought together representatives of the Society of General Internal Medicine, the Society of Teachers of Family Medicine, and the Academic Pediatric Association to discuss evidence related to the PCMH and to recommend policies to advance the model. One of 5 expert workgroups at this conference focused on research and policy priorities related to integration of primary care and behavioral health (encompassing both mental health and substance abuse). Members of this workgroup have authored an article in this issue of Pediatrics.1 They make a strong case for the benefits of integrating behavioral and primary health in the PCMH and summarize the workgroup’s recommendations for policies supporting practice and research regarding integrated models.
The workgroup sought to address behavioral health needs across the full spectrum of severity: those individuals who are at risk but not yet symptomatic and those with emerging symptoms, as well as those experiencing impairment from disorders. The workgroup’s 5 recommendations were to: (1) build well-funded demonstration projects to test various approaches to integration; (2) identify best practices and develop interdisciplinary training programs to support members of the integrated care team; (3) implement strategies to improve behavioral health at the population level; (4) eliminate behavioral health carve-outs and test new payment models that encourage and support integration; and (5) develop new measures to evaluate the impact of integration on population health and society as a whole. This agenda aligns well with the work of the American Academy of Pediatrics’ Task Force on Mental Health.2–4
For future projects, youth and families (including those served by the behavioral health system) will be needed to advise those who are planning and evaluating integrated PCMH models. Children with severe mental illness use primary care services less frequently than do those without mental illness.5 Many have not experienced the benefits of the PCMH; however, they may have benefited from specialized supports in the behavioral health system, such as community health workers, patient navigators, and peer advocates. Some behavioral health advocates with these realities in mind (and the knowledge that people with severely impairing behavioral health conditions die of medical causes many years before their peers6) believe that the ideal form of integration is the addition of primary care services to the behavioral health care setting; this model is encompassed by the term “health home” in the Patient Protection and Affordable Care Act of 2010.7 It will be important to compare costs, patient experience, and outcomes in this model versus PCMH models. It will also be necessary to provide reassurance to behavioral health advocates that payment reforms such as elimination of carve-outs do not result in decreased financial support for the behavioral health specialty system.
The PCMH research conference of 2013 has outlined an ambitious and worthy research and advocacy agenda for the integration of behavioral health and primary care. It is gratifying to see that the primary care research community has united behind it. It will be critical to involve youth and parents affected by behavioral health conditions in advancing this agenda.
- Accepted February 27, 2015.
- Address correspondence to Jane M. Foy, MD, FAAP, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157. E-mail:
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.
COMPANION PAPER: A companion to this article can be found on page 909, and online at www.pediatrics.org/cgi/doi/10.1542/peds.2014-3941.
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- 3.Committee on Psychosocial Aspects of Child and Family Health; Task Force on Mental Health. Policy statement—the future of pediatrics: mental health competencies for pediatric primary care. Pediatrics. 2009;124(1):410–421
- 4.↵American Academy of Child and Adolescent Psychiatry Committee on Health Care Access and Economics Task Force on Mental Health. Improving mental health services in primary care: reducing administrative and financial barriers to access and collaboration. [published correction appears in Pediatrics. 2009;123(6):1611]. Pediatrics. 2009;123(4):1248–1251
- 7.↵Centers for Medicare & Medicaid Services. Health homes. Available at: www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Integrating-Care/Health-Homes/Health-Homes.html. Accessed February 25, 2015
- Copyright © 2015 by the American Academy of Pediatrics