Taking Mental Health-Primary Care Integration to Scale: Designing a System-Wide Program to Improve Care and Reduce Costs

Abstract

A quarter of American adults suffer from mental health disorders every year and primary care physicians manage between 40-80% of these patients. Rates of detection and adequate treatment in the primary care settings are suboptimal, leading to poor outcomes and excess costs. Here we present a strategic plan for a new initiative that integrates mental health and primary care across the Partners HealthCare network with the goal of improving clinical outcomes and reducing medical expenditures for the target population. We describe a comprehensive clinical service model built around five core tactics: 1) enhanced detection 2) coordinated mental health and primary care services 3) evidence-based care protocols 4) streamlined access to specialty care and 5) comprehensive monitoring and follow-up. We also outline a staged implementation strategy, and describe an in-depth plan for monitoring and evaluation. Finally, we construct a detailed financial model that projects cost savings associated with program under alternative payment contracts. We find that the intervention should reduce total costs by $70.85 million over 3 years. At an estimated implementation cost of $18.19 million, this represents a net savings of $52.66 million—a return on investment of nearly 3 to 1.