Dr Roger Kathol Explains the Integration of Behavioral Health

The integration of behavioral healthcare into a medical setting is being delayed by resistance from those benefiting from the current payment model, said Roger Kathol, MD, president of Cartesian Solutions, Inc., and adjunct professor of psychiatry at the University of Minnesota.

What is the current status of the integration of behavioral health services?

So we’re really in a transition period—probably for the past 10 to 15 years, we’ve understood that psychiatric problems in the medical setting are a significant issue and actually a major cost. However, there’s a number of transitions that are needed before behavioral healthcare can be delivered in the medical setting, and that’s really what we need to do.

Rather than building out a separate behavioral health setting, we need to put behavioral health services in the medical setting. So the first thing is changing the payment system so that behavioral health providers can make a living by providing services in the medical setting. And also transitioning to an approach to care that allows them to give what I call value-added services in the medical setting.

So we’re really sort of at the beginning, sort of into the middle stages of that, but the major change that needs to occur has not happened yet and that is a change in the way that we pay for behavioral health services. Basically they have to go from a separate payment system to becoming part of medical benefits.

What is hindering the transition of behavioral healthcare into the medical setting?

Well, there are changes in practice first of all. Clinically, it takes time to change, for practitioners to learn new methods of approaching mental health and substance abuse disorder problems. But one of the major difficulties is that the way the payment system is set up, the people that pay for behavioral health services today, separately from medical services, make their money by doing that. They don’t want to give that up, and that’s a real challenge to do the transitions of the medical payers.

The insurance companies that pay for all the rest of medical or health benefits can assume the responsibility for putting the behavioral health into their contracts for care in the future. So there’s a resistance and there’s also a natural change process which usually takes somewhere between 15 to 20 years to complete.