In our insurance underwriter meetings, I am frequently reminded during the budget discussions that the muscle managing our government-mandated insurance programs is broke. With our deficit spending forecasted in 2013 at $845 billion, total debt greater than $16.1 trillion, poverty at 15.1 percent and total health care spending near 18 percent GDP– many agree that cause for concern is warranted. For example, the ACA provides regulations that allow Medicare to encourage the use of primary care providers (PCPs) to deliver preventative and appropriate healthcare– which reduce costs and improve outcomes. Such arrangements include incentives to PCP healthcare providers, escalated rates for PCPs and funding for training the PCP workforce. Additionally, the ACA also provides regulations that allow Medicare to encompass the Mental Health Parity and Addiction Equity Act of 2008– or, equal payments for mental health (MH), substance use and medical services– to reduce costs and improve outcomes. These provisions include incentives to coordinate medical and Mental Health services, enhance community-based service options for MH conditions and reform delivery-systems to address traditional system fragmentation. About one-third of all Medicare beneficiaries have been diagnosed with a cognitive or mental impairment. Nearly 6.5 million Americans– or 18 percent– aged 65 and older suffer from depression. Those with chronic conditions such as cancer, diabetes and heart disease are 2-5 times more expensive to treat (PDF) if they also have depression. An estimated 70 percent of primary care visits (PDF) have a psychological component to the visit– such as smoking, a sedentary lifestyle, non-adherence, substance abuse and obesity. Furthermore, of the countries that underscore PCP use with significantly less GDP spending on health care– included behavioral health care in primary care settings are amply employed:. Mental health matters are first addressed with the PCP and MH specialist, and then referred to outside services when necessary.

In the U.S., employing large-scale integrated services requires additional system changes. Current code modifications for reimbursing integrated MH specialist consultations could encourage current PCPs to integrate services. Medicare can also reimburse for incorporated MH care deliveries and services in PCPs– and vice-versa. Undoubtedly, special interest groups in both the medical and behavioral health field may be hesitant to change. Yet, what reform hasn’t stirred-up opposition?