Patients receiving care in team-based practices that integrated mental and physical healthcare services had better clinical outcomes, lower total costs and used fewer healthcare services, according to a 10-year study conducted by Intermountain Healthcare researchers.
Intermountain Healthcare researchers conducted a 10-year study on the impact of delivering integrated mental and physical healthcare in team-based primary care settings, and the study was recently published in the Journal of the American Medical Association. Brent James, M.D., Intermountain’s chief quality officer and executive director of the Intermountain Institute for Healthcare Delivery Research, led the study and researchers measured 113,452 adult patients who received care from 2003 through 2013 in 113 primary care practices at Intermountain, including 27 team-based medical practices and 75 traditional practices.
As a result of the integrated mental healthcare model, Intermountain researchers found that a higher rate of patients in team-based practices were screened for depression, which enabled care providers to provide medical and behavioral interventions earlier, compared to patients in traditional practices. As a result, 46 percent of patients in team-based practices were diagnosed with active depression compared to 24 percent in traditional practices.
The study findings indicated that more patients in team-based practices adhered to diabetes care protocols, including regular blood glucose testing, specifically 24 percent compared to 19 percent in traditional practices. In addition, close to half (48 percent) of patients in team-based practices had a documented self-care plan to help them manage their health conditions, compared to 8 percent in traditional practices.
The researchers also found that the integrated mental healthcare resulted in lower rates of healthcare utilization, such as a reducing emergency room visits by 23 percent. Specifically the data showed that per 100 person years, the rate of emergency room visits was 18.1 for patients in team-based practices versus 23.5 visits for patients in traditional practices.
The rate of hospital admissions was 9.5 for patients in team-based practices versus 10.6 in traditional practices, which represents a reduction of 10.6 percent.
In addition, the number of primary care physician encounters was 232.8 for patients in team-based practices versus 250.4 for patients in traditional practices, which is a reduction of 7 percent.
And, researchers found that the integrated model resulted in lower total costs. Payments to providers were $3,400 for patients in team-based practices versus $3,515 for patients in traditional practices, which is a savings of 3.3 percent. According to the study authors, the payments were less than the investment costs Intermountain incurred in creating the team-based practice model.
Prior to this study, limited evidence was available to support the effectiveness of a care model that integrated mental health providers with primary care teams, according to the study authors.
“For patients, the bottom line of the study is that getting care in a team-based setting where medical providers work hand-in-hand with mental health professionals results in higher screening rates, more proactive treatment, and better clinical outcomes for complex chronic disease,” Intermountain Healthcare scientist Brenda Reiss-Brennan, PhD, APRN, one of the study's authors, said in a statement. “Team-based care means providers work together to care for all chronic conditions, mental and physical.”
Intermountain has embedded mental health screening and treatment within primary care physicians' offices since 2000.
“The study reinforces the value of coordinated team relationships within a delivery system and the importance of integrating physical and mental health care,” Reiss-Brennan said. “The study provides further evidence—from a mental health perspective—of Intermountain Healthcare's hypothesis that better care costs less.”
