Primary Care Integration of Psychiatric and Behavioral Health Services: A Primer for Providers and Case Report of Local Implementation.

Mental health conditions are common, disabling, potentially life-threatening, and costly; however, they are mostly treatable with early detection and intervention. Unfortunately, mental healthcare is in significantly short supply both nationally and locally, and particularly in small, rural, and relatively isolated communities. This article provides physicians and other health practitioners with a primer on the basic rationale and principles of integrating behavioral healthcare - particularly psychiatric specialty care - in primary care settings, including effective use of teleconferencing. Referring to a local-based example, this paper describes the programmatic components (universal screening, telephone availability, mutually educational team rounds, as-needed consultations, etc) that operationalize and facilitate successful primary care integration, and illustrates how these elements are applied to population segments with differing needs for behavioral healthcare involvement. Lastly, the article discusses the potential value of primary care integration in promoting quality, accessibility, and provider retention; discusses how new developments in healthcare financing could enhance the sustainability of primary care integration models; and summarizes lessons learned.

Mergers and health care organizations.

The concerns over ever-rising health care costs has motivated physicians, hospitals, and insurance carriers to search for ways to increase efficiency, decrease costs, and maintain or improve quality. Mergers have been recognized as having the capability to accomplish all three goals-but not without some concerns. This article's intent is to provide the reader with basic knowledge that will assist in understanding the discussion regarding the appropriateness of mergers in health care. It reviews issues raised by mergers and examines a few case studies of merged health care organizations.