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Building Healthier Minds (and Bodies) in Rural America

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic's best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how two Patient-Centered Medical Homes in rural Maine are integrating behavioral health needs with medical care to build healthier, happier communities.

Kennebec Behavioral Health (KBH) in Augusta, Maine was facing a perfect storm of mental health concerns.  It was staring down sky-high rates of anxiety and depression, along with growing reports of substance abuse and domestic violence.  The central Maine health system, whose four community mental health centers serve 16,000 patients annually, was experiencing some of the classic symptoms of a rural region affected by economic uncertainty, unemployment, and isolation.

Central Maine’s residents are no strangers to behavioral health needs.  Unfortunately, they are also familiar with barriers to access, including lack of sufficient insurance coverage, a shortage of care facilities like KBH’s, and transportation difficulties. Rough Maine winters block transport for those in need of care and, in a cruel twist, sometimes even contribute to seasonal depression.  The lack of access to quality mental health care has contributed to a wide array of health concerns—and not just behavioral.

In fact, studies suggest that mental and physical health are closely tied. Mortality rates for cardiovascular disease are 67 percent higher in patients suffering from depression.  Likewise, poor general health leads to an increased incidence of mental illness.  Conversely, some conditions—including diabetes, high blood pressure, and high cholesterol—have been shown to actually improve when addressed along with mental health. Yet across the country, mental health and medical care are often treated separately.

The Patient-Centered Medical Home for Behavioral Health

In rural Maine, the proliferation of patient-centered medical homes (PCMH) is helping to address many of these challenges. The PCMH model of care delivery—which surrounds the patient with a primary-care “home” that affords access to specialists in mental and behavioral health—is especially suited to rural areas, where such specialists are in short supply.  By integrating mental-health specialists directly into a primary-care facility, patients gain easier access to specialized treatment through their primary-care facility.

Harrington Family Health Center’s idyllic location, nestled between blueberry barrens and the Atlantic coast, conceals difficult population health conditions. Many of Harrington’s patients are engaged in hard, seasonal work and suffer from chronic health conditions.  As a PCMH, Harrington provides not only primary care but also behavioral health care and wellness and prevention services. Across Maine, Harrington has established a network of 22 behavioral health organizations that work out of 50 participating PCMHs. These “Behavioral Health Homes” are focused on adults with severe and persistent mental illness, or children with serious emotional disorders. Care is delivered with an intense focus on integration and on communication amongst providers as they act as one coordinated care team.

Improved Care, Reduced Costs

In rural Maine, advances in the integration of medical and behavioral health are improving population health and, in some cases, have even lowered the overall cost of care.

Together, Behavioral Health Homes and PCMHs are improving care for patients in Maine while reducing costs through more efficient allocation of resources. Integrating mental health into primary care, for example, addresses some of the strain unmet behavioral health needs put on the health care system.

The value of integrating mental health with primary care in rural communities extends beyond direct savings, too. For rural communities, Behavioral Health Homes and PCMHs have made it easier to attract and retain qualified care providers. 

In remote locations, the emphasis on integrated care models has helped PCMH's recruit and retain strong talent.  That unexpected value is paying dividends, setting up rural Maine communities like Harrington’s for long term access to healthier minds and bodies.


Caroline Smart is a Senior PR Associate and CloudView Editor.

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