Increasing access to integrated models of primary and behavioral health care in rural and urban areas of Michigan

December 10, 2022

Three lines combine into an arrow moving up and to the right.Nationally, mental health needs increased over the last several years, exacerbated by the coronavirus disease 2019 (COVID-19) public health emergency that began in March 2020. A 2021 survey found that “…31.6 percent of adults in the U.S. reported symptoms of anxiety and/or depressive disorder, up from 11.0 percent in 2019.”

Primary care and BH providers offer a range of services to treat patients with BH conditions. These providers may work together to provide integrated primary care and BH services and may use telebehavioral health services to address BH needs. This study included a literature review for research and benchmarks about delivery of BH services by provider type and geography, as well as analysis of Blue Cross Blue Shield of Michigan (BCBSM) preferred provider organization (PPO) and health maintenance organization (HMO) claims for commercially insured members from 2019 to 2021. Our study also focuses on rural areas in Michigan, which generally have worse health outcomes than urban populations, and residents may have difficulty accessing specialty services.

Key findings

Our study found an increase in the use of BH services from 2019 to 2021, particularly for telebehavioral health and integrated care services. There were disparities in the use of these services among metro versus rural members, which may be due in part to lack of BH providers and broadband access in rural areas. Addressing these underlying access issues may help close this gap.

From 2019 to 2021, the use of telehealth services soared in all geographic regions in Michigan. Telehealth has often been touted as a means to close the gap in use of BH services, yet geographic disparities remain. In 2021, 28% of PPO members in metro counties had a telehealth visit, twice the rate of members in rural counties (14%). This difference was greater for HMO members—28% in metro areas compared with only 11% in rural areas.

A very small percentage of all members with BH diagnoses had claims for integrated care services in 2021 (0.4% in both PPO and HMO populations). This proportion has been steadily growing in recent years, likely due to a growing awareness of integrated care billing codes among providers and the introduction of an additional integrated care code in 2021.

Trends in this study may have been due in part to broad increases in the use of telebehavioral health services and the overall need for BH care because of the COVID-19 pandemic. Going forward, it may be key for policymakers to act to support telehealth as a necessary and effective form of providing care BH services even as COVID-19 becomes endemic.