There is an inextricable and well-documented connection between physical health and behavioral health. Behaviors such as smoking, alcohol and drug abuse, eating low-nutrition foods, lack of exercise, and insufficient sleep can greatly affect an individual’s physical health.
Conversely, poor health can contribute to depression, substance abuse, and inactivity, perpetuating a vicious cycle that can ruin lives and contribute to healthcare costs. The impact of social determinants of health (SDoH), including lack of transportation or housing, unemployment, and discrimination, can exacerbate both physical and mental health problems.
These issues are particularly prevalent among underserved populations, such as rural Americans, for whom behavioral health support and services either are inaccessible or not integrated with their primary care. As the National Institute for Health notes, though, “the prevalence of serious mental illness and most psychiatric disorders is similar between U.S. adults living in rural and urban areas; adults residing in rural geographic locations receive mental health treatment less frequently and often with providers with less specialized training, when compared to those residing in metropolitan locations.”
While primary care providers long have been aware of these challenges and inequities, far too often they are unable to do anything about them due to a lack of resources. To encourage tighter integration of behavioral health into primary care for these populations, the Centers for Medicare and Medicaid Services (CMS) has created a primary care reimbursement model to enable a more equitable, innovative, and team-based approach.
For some healthcare organizations, particularly low-revenue providers in rural areas, integrating primary and behavioral care remains a formidable challenge. Among the most common obstacles are lack of funding or resources to fully integrate the two types of care and a shortage of qualified behavioral health professionals in the service area.
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