Why Behavioral Health Integration Matters to Health Plans


Mental and Physical Health

A key feature of CareMore Health’s advanced primary care model is seamless integration with behavioral health services. Through our sister company, Carelon Behavioral Health, we can provide referrals to a behavioral health clinician, meeting health plan members’ needs for prompt assessment or treatment. As noted below, many patients – regardless of health status – have co-occuring behavioral health needs. Behavioral health is an important aspect of whole-person care, addressing members’ medical and psychosocial needs. Other benefits of behavioral health integration include:

Patients with chronic conditions need mental health care.

A chronic condition affects not only the body. It can lead to mental health challenges like depression or anxiety. For example: Someone diagnosed with diabetes may be facing new limits on what he/she can do and feel stressed or concerned about the future. It can be hard to adapt to a new reality and cope with changes like diet and taking medications. Favorite activities, like hiking or gardening, may be more difficult.

Chronic patients deal with many physical and medical challenges, which also affect mood and mental health. These patients can benefit from access to behavioral care as part of their treatment.

Mental health is part of primary care.

CareMore’s advanced primary care model recognizes the mind-body connection and the inseparability of mental and physical health. According to the American Academy of Family Physicians “up to 75% of primary care visits include a mental or behavioral health component.” In the wake of the Covid pandemic, the need for mental health services is increasing.

Behavioral health is an important part of prevention.

The key feature of advanced primary care is prevention and early intervention. Keeping people healthy today and preventing disease will reduce the need for more expensive interventions in the future. Mental health is an important part of prevention. Members who have unresolved mental health problems are less likely to comply with preventive health measures. They may skip doctor appointments and not attend preventive screenings. The best way to ensure compliance and participation in preventive care is to treat mental health.

Older Medicare patients need behavioral healthcare.

The challenges of aging bring higher incidence of behavioral health disorders. As patients age, the incidence of depression and anxiety increases. With many seniors struggling with financial insecurity, social factors come into play like healthy food, housing and transportation.

Many older members also face loneliness. Some become alienated from their families as children move away or become busy with their own families and careers. Loneliness can have a serious impact on mood and well-being. The health effects of loneliness are comparable to a heavy smoking habit. Behavioral health treatment can address loneliness by helping the member connect with family and community resources.

Support primary care doctors in providing whole-person care.

In the CareMore advanced primary care model, behavioral health forms a close partnership with the primary care doctor. While many patient visits have a behavioral health component, the physician may not be comfortable or qualified to address these needs. Our partnership with Carelon Behavioral Health gives the physician a valuable resource for addressing behavioral needs in their patients. Easy referral to behavioral health reduces physician burden by allowing the doctor to focus on medical needs of their other patients.

Integrated, team-based care team produces better patient experience.

Healthcare is a team sport. And this is especially true when the patient has a chronic or complex condition. Members benefit from an integrated clinical team led by a primary care physician, with nurses, specialty physicians, community health workers and behavioral health clinicians. CareMore’s relationship with Carelon Behavioral Care promises timely and seamless referrals, enabling members to get the care they need when it matters most.

Member satisfaction by providing whole-person care.

Carelon, our parent company, has as its mission to solve complex healthcare challenges and deliver whole-person health. CareMore specializes in the most challenging subset of health plan members: those with chronic and complex disease. Our Healthy Start™ assessment reviews the member’s full picture of medical, behavioral and social needs. Appointments run longer than the typical 15 to 20 minutes – up to 45 minutes to an hour.

The Healthy Start™ assessment can be followed by appointments in-clinic, virtual or at-home. Home visits are especially effective at assessing social needs such as nutrition, housing, transportation and family relationships. These factors are known to affect 80 percent of health, and all affect behavioral health. By addressing social factors and related behavioral conditions, we improve the member’s well-being, boost engagement and adherence to a treatment plan.

Difficulty getting BH referral or consult.

Due to provider shortages and high patient demand, behavioral health referrals currently are difficult to place. Our sister company, Carelon Behavioral Health, offers responsive, timely referrals for behavioral health treatment. Members can be seen in clinic or virtually at home, at a time and place most convenient. Patients with a behavioral condition benefit from prompt appointments and the seamless care provided across the treatment continuum.

Best approach for evolution to value-based care.

In value-based care, providers are rewarded for value over volume. With capitated or bundled payments, providers step off the fee-for-service treadmill to focus on patient health and well-being. Many providers attest that this is their preferred way to practice medicine. Under value-based care, providers assess the patient’s whole-health needs, including behavioral, and creatively offer services to bring about the best outcome.