Integrating behavioral health services into primary care settings increases the chance that people get treatment for opioid use disorder – without raising costs, a recent study shows.
The Centers for Medicare and Medicaid Services aligned more than 2,000 primary care practices in the U.S. – including some in the Philadelphia region – with private insurance carriers between 2017 and 2021 in an attempt to improve patient outcomes and reduce costs. Primary care practices in the program, called Comprehensive Primary Care Plus, received additional financial resources based on how well they performed on certain measures, such as patient experience and clinical quality.
These primary care practices integrated behavioral health treatments in a variety of ways, including screening for depression, anxiety and substance use issues. They also used teams of nurse practitioners, physician assistants, substance use and mental health counselors and social workers.
A study of 190,000 Independence Blue Cross members treated at CPC+ practices found that people with opioid use disorder were more likely to fill prescriptions for anxiety drugs and buprenorphine, a medication that helps alleviate cravings for heroin, fentanyl and other opioids, compared to people treated at practices outside the CPC+ model. There was no difference in total treatment costs for patients at CPC+ practices and other primary care clinics.
The study, published in late April in JAMA Open Network, was conducted by researchers from the University of Pennsylvania and Tulane University. Its findings suggested that CPC+ practices were associated with "moderately higher utilization" of mental health services and substance use treatment for patients diagnosed with opioid use disorder, depression or anxiety after the COVID-19 pandemic began.
Part of the reason for the improved behavioral health outcomes in the CPC+ practices was because they made it "easier or more convenient or more accessible for patients to actually be able to access both primary care and mental health services and sometimes substance use services in the same kind of care setting," said lead study author Tatiane Santos, an assistant professor at Tulane and an adjunct senior fellow at Penn's Leonard Davis Institute of Health Economics.
Bringing behavioral health treatment into a primary care setting also helped people who may have avoid treatment due to the stigma of seeking help from addiction treatment and mental health providers, Santos said.
Though Santos said primary care providers are underfunded, she is optimistic about the future of primary care.
"There's a lot of great work happening with these large, innovative models," such as CPC+, Santos said. "When you have a bird's-eye view of the entirety of primary care transformation and reforms, it is moving in a direction we would like it to move. It's just very slow to get there."
