Lessons from Implementation of Behavioral Health Integration in Kaiser Permanente Washington


Rebecca Parrish, MSW; Ryan M Caldeiro, MD; Amy Lee, MPH


Abstracts from the Kaiser Permanente 2019 National Quality Conference 

From Washington

Background: Behavioral health conditions and psychosocial and resource barriers to accessing care are ubiquitous in primary care settings and are associated with poor physical health and increased health care costs when undertreated or unaddressed. Kaiser Permanente (KP), like other health systems in Washington and across the country, is working to improve access, reliability, and quality of care for patients with mental health and substance use concerns through behavioral health integration (BHI) within primary care clinics.
Methods: Primary care-based universal screening for adults age 18 years and older for depression and unhealthy alcohol, marijuana, or other drug use. Positive test screenings are assessed with evidence-based tools with results documented in the electronic health record, resulting in patient-centered care including preventive advice and shared decision making to determine appropriate treatment. Licensed clinical social workers and community resource specialists function as core members of the primary care team who can help support the care needs identified from screening. Outcome measures include screening and assessment rates for depression, alcohol- and substance-use disorders, as well as suicide risk assessment and decrease in referrals to specialty mental health.
Results: Screening and assessment rates for common and easily treatable mental health conditions improved significantly following implementation of BHI. Prelaunch, 10% of patients received depression screening vs an organizationwide 90% screening rate in September 2018. Similarly, 6% of patients received depression assessment prelaunch vs organizationwide assessment rate of 97% in September 2018 when BHI was launched in all KP Washington (KPWA) clinics. Improved screening and assessment rates have been sustained for more than 3 years in clinics that led the development of the work in 2015. In a recent KPWA provider poll, BHI was rated in the top 5 primary care investments that supported improved patient experience, improved practitioner experience, improved quality, and decreased costs.
Discussion: Integrating behavioral health into primary care has substantially improved the ability of KPWA to identify and to treat common mental health and substance-use concerns. Key facilitators to success include: Intentional staff engagement around implementation; defined standard work to support screening, assessment, and treatment of identified conditions; and the addition of staff members dedicated to supporting the needs identified via screening. Well-executed BHI results in: Improved patient care and experience, improved organizational performance on mental health quality measures, and increased practitioner satisfaction. KPWA learnings applied in your Region can support more fully integrated health care.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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