THE INTEGRATION OF PRIMARY CARE AND
BEHAVIORAL HEALTHCARE IN NORTHERN
Robin A. Dea, M.D.
Integration of behavioral healthcare and primary care has a number of pre-
sumed beneﬁts, including better communication between providers and systems,
leading to improved patient care. There are studies showing medical cost offsets,
although they tend to be in circumscribed research settings. Northern California
Kaiser-Permanente has designed a new primary care system providing mental
health clinicians on a primary care team. Those clinicians evaluate patients,
create treatment plans, provide brief interventions, coordinate care with spe-
cialty behavioral healthcare, and consult with primary care physicians. Those
physicians also have an increased role in the detection and treatment of behav-
ioral health problems via guidelines developed with behavioral health. Struc-
tural changes within the overall system, including regional call centers and com-
puterized clinical information systems, support the integration. Quality
programs also support the ongoing improvement of the integration process.
There are investment expenses in this type of re-design, but also expected cost
savings. An infrastructure is now in place to measure both clinical outcomes,
and cost effects of the new model.
The concept of integrating behavioral healthcare into primary
care settings has been a popular one in the Managed Behavioral
Robin A. Dea, M.D., is Chair, Chiefs of Psychiatry, Kaiser-Permanente, North-
Address correspondence to Robin A. Dea, M.D., 1150 Veterans Blvd., Redwood
City, California 94063.
PSYCHIATRIC QUARTERLY, Vol. 71, No. 1, Spring 2000
0033-2720/00/0300-0017$18.00/0 2000 Human Sciences Press, Inc.