For decades, Massachusetts has been an innovative leader in developing behavioral health programs and policies and implemented various statewide provider consultation programs aimed at addressing specific behavioral health (BH) conditions. However, the Commonwealth currently lacks a statewide program for primary care providers (PCPs) to consult with BH specialists about their adult patients’ BH conditions.
Commonwealth Medicine’s new report with the Blue Cross Blue Shield of Massachusetts Foundation — Help for the Front Line: Approaches to Behavioral Health Consultation for Primary Care Providers — suggests that a PCP-to-BH provider consultation program may help PCPs more effectively address their adult patients’ needs. Offering PCPs real-time access to BH specialists for treating mental health and substance use disorders (SUDs) may help close the gap in access to BH services.
Applying a consultation program concept to the primary care setting
PCPs have always been on the front line of BH care, often the first to detect that their patients need help. These days, that need is even more acute and prevalent, as individuals in our communities face mental health challenges due to the pandemic and other societal stressors.
Recognizing this, the Foundation turned to Commonwealth Medicine to help assess the need for a PCP-to-BH specialist consultation program and, if implemented, whether PCPs would utilize it. The study also sought to understand the BH conditions PCPs encounter, the associated proportion of adult patients with BH needs, and the barriers PCPs face in supporting these patients.
Commonwealth Medicine applied a mixed-methods approach by conducting a literature review of existing consultation programs and a statewide survey of nearly 500 PCPs, followed by in-depth interviews with 10 survey respondents to contextualize the survey findings. Some key highlights from the study include:
- PCPs overwhelmingly report encountering mental health conditions among their adult patients – 99% encounter patients with depression and anxiety, 94% encounter SUDs, and 80% encounter persistent mental health conditions.
- PCPs reveal relatively low levels of satisfaction with their current approaches for addressing the BH needs of their adult patients and express considerable interest in a potential consultation service, assuming it were designed with their preferred features.
- The preferred services and features for a PCP-to-BH provider consultation program include referrals to prescribing and non-prescribing BH providers, medication prescribing and management consultation, real-time consultation via phone, and online consultation with response in real time or within 12 hours.
Part of a larger strategy to improve BH care and access
In revealing the need and interest in setting up a real-time connection between PCPs and BH specialists in the primary care setting, Commonwealth Medicine’s study offers an added opportunity to enhance Massachusetts’s comprehensive and multipronged strategy to improve BH care and access.