Day-to-day behaviors such as diet, exercise, and sleep significantly affect health outcomes. However, primary care doctors often lack the time to address these behavioral health changes in detail during patient visits.
A Rutgers Health study published in the Journal of the American Board of Family Medicine explored integrating behavioral health services into primary care settings to enhance patient outcomes. Ann Nguyen, the lead author and an assistant research professor at the Center for State Health Policy within the Rutgers Institute for Health, Health Care Policy and Aging Research, noted that more than 70% of primary care visits involve some aspect of behavioral health. However, conventional primary care visits often limit physicians to brief interactions.
“The typical primary care doctor spends 15 to 20 minutes with you, tops,” Nguyen said. “That’s not enough time for somebody with a complex condition to tackle everything that’s going on.”
The study focused on 10 federally qualified health centers and community health centers in New Jersey that implemented the Cherokee Model of integrated care from 2013 to 2019. They continued to offer integrated behavioral health services beyond the initial funding phase. The Cherokee Model enables patients to benefit from a “warm handoff” to a behavioral health clinician immediately after seeing their primary care physician, all within the same facility.
“We really want to see behavioral and physical health happening all under the same roof as part of the same visit,” Nguyen stated. “Once you require patients to go to a different place, on a different day, with another copay, you create a significant barrier.”
The Rutgers researchers identified six strategies that led to long-term success: engaging experienced change champions to secure staff buy-in, providing specialized training on brief interventions, setting up ongoing training for new staff, creating dedicated spaces near examination rooms, establishing efficient scheduling systems, and identifying billing codes and procedures.
Despite these successes, challenges persist in achieving widespread adoption. Reimbursement rates for behavioral health services may not cover costs, and healthcare systems often treat behavioral and physical health as separate areas. Many practices also face space and workflow difficulties.
Health centers with space constraints adapted creatively, such as using hallway workstations or allowing behavioral health consultants to operate from the front desk during patient visits.
Research supports that integrated behavioral health services improve clinical outcomes for conditions like depression, anxiety, and substance use disorders. They also enhance patient and provider satisfaction and reduce system costs through preventive measures.
“This is not only a treatment model, but also a prevention model,” Nguyen explained. “We’re catching things and changing behaviors early on, so patients don’t later on need expensive specialized services or end up in the ER.”
The study's scope is extending nationally, examining successful systems of implementing integrated behavioral health, while developing automated reports to showcase the financial and clinical benefits.
“Behavioral health is a huge challenge, not just in terms of devising effective and economical ways that providers can offer it but also in terms of actually changing patient behavior,” Nguyen said. “Still, it’s vital that we find strategies that work because how patients behave day-to-day has a greater impact on wellbeing than anything we can do for them after they get sick.”
