There is a movement across the country to integrate behavioral healthcare into primary settings. This model not only facilitates access for patients with mild to moderate behavioral health conditions, but has also been shown to markedly reduce overall medical costs.

Integrating behavioral health and primary care ensures patients with behavioral health needs receive help. It also means the medical needs of patients with mental illness are addressed in a timely way.

"Many people with comorbid behavioral health problems, such as depression and substance abuse, receive medical care in primary care offices, yet they lack access to expert behavioral healthcare providers," said Blaine Greenwald, M.D., executive director and vice president of behavioral health services at Northwell Health and vice chair of psychiatry at Long Island Jewish Medical Center and North Shore University Hospital.

One catalyst to help fast-track the integration of behavioral health and primary care at Northwell is New York State's Delivery System Reform Incentive Payment (DSRIP) Program. Established by Gov. Andrew Cuomo in 2014, this initiative focuses on reducing avoidable hospitalizations by 25 percent over five years, aided by an $8 billion federal grant.

Behavioral health comorbidities can complicate medical conditions, leading to increased medical hospitalizations. This makes collaborative, multidisciplinary care a key component of reducing unnecessary hospitalizations.

"Embedding a social worker, psychologist or mental health counselor within primary care offices lets the general practitioner collaborate with a behavioral health professional to address psychiatric issues that may not be so obvious," said Rajvee Vora, M.D., psychiatrist and medical director for behavioral health at Northwell Health Solutions, which oversees DSRIP throughout the health system. "At Northwell, physicians and behavioral health specialists have access to an off-site consulting psychiatrist."

The model lets patients access behavioral healthcare in the same place they routinely visit for primary care.

The DSRIP initiative also addresses the medical needs of psychiatric patients who typically do not see a primary care physician in an outpatient setting through what's called "reverse integration."

"Patients with serious psychiatric illnesses, such as schizophrenia, commonly do not receive adequate medical treatment," Greenwald said. "Furthermore, psychiatric illness may compromise a patient's ability to navigate medical or surgical services and comply with medical treatments. Reverse integration brings primary care to psychiatric settings."

In the summer of 2016, an internist began seeing patients at Zucker Hillside Hospital's outpatient clinic to conduct annual physical exams and preventive screenings and administer vaccinations.

"This is truly integrated care, made more seamless by the use of a shared electronic health record [EHR]," Vora said. "The internist documents care in the same EHR as the psychiatric team, so the psychiatrist can gain a fuller understanding of the patient's physical needs, and the internist is informed about the patient's psychiatric status."

The new program saw a significant increase in the number of Zucker Hillside patients who saw their internist on the same day as their psychiatric appointments. Clinicians are tracking the efficacy of reverse integration with measures such as the number of annual physicals for the outpatient clinic's patients, lab tests that monitor diabetes and adherence to diabetes medications, and body mass index.

"People with serious behavioral health conditions deserve good care for their overall health," Vora said. "We need to meet them in the setting where they are most comfortable to help make that happen."