Behavioral health continually surfaces as an area of opportunity for the medical community. It is estimated that 25 to 30 percent of all primary care patients could benefit from behavioral health interventions, yet the health care system has struggled to provide the resources required to meet this need.
There are a number of primary care providers within the Coordinated Care that have narrowed this gap by exploring solutions like co-location, integration and telehealth. This has allowed those providers to further enrich patient experience by improving access to behavioral health care and reducing associated stigma.
Starting with co-location of services.
Co-location refers to services or providers that are located in the same physical space but may not be fully integrated with one another. Because this model presents opportunities to streamline referrals, diversify payer mix and improve communication between providers, many behavioral health professionals see co-location at primary care practices as an appealing arrangement.
Licensed clinical social workers offer the most versatility in these types of relationships. They may dedicate a few hours each week to see patients at a primary care provider’s office, or they may agree to be on-site full time if patient volume is sufficient to support that level of service. Having a specialist on-site allows the treatment team to communicate directly with the behavioral health provider.
Co-location is not without challenges, however. While primary care and behavioral health clinicians occupy the same space, they often practice independently, relying on traditional referral models and maintaining separate systems for medical record-keeping and billing. Providers must prioritize communication or risk the benefits a treatment team provides.
Graduating to integrated care.
The primary goal of most integrated care programs is to improve communication between primary care providers and behavioral health specialists to address mental health and physical problems in a comprehensive, coordinated and collaborative manner.
Cost and reimbursement remain the biggest barriers to adoption. But as health care moves away from fee-for-service payment models and providers are given responsibility for the overall health of patient populations, those barriers are slowly becoming surmountable.
A growing number of Coordinated Care medical practices are finding success in embedding a behaviorist as a full-time staff member. Much like co-location, this solution delivers team-based collaborative care; however, it also allows group providers to draw upon shared knowledge, principles and care plans to work toward patient goals. Shared clinical records and billing systems help close any potential gaps that may otherwise occur.
The most innovate health systems are piloting telehealth as a resource for mental health care – UCHealth among them.
Primary care practices that have been unable to successfully co-locate or embed a behaviorist can offer this as an alternative resource for patients requiring mental health care. To effectively execute this strategy, physicians should first establish strong rapport and understanding with their preferred behaviorist. And then take it slow, easing into the relationship and having patients engage via telehealth with the mental health professional from the familiar surroundings of the primary care physician’s office.
In any of these situations, it is critical that the behavioral health provider be very accomplished in all behavioral health resources available to patients. Some patients may require more intensive services like inpatient care, partial hospital care, intensive outpatient care or individual care. The clinicians must also be very flexible about being interrupted, working as part of a care team and have the ability to perform cognitive behavioral therapy.
Coordinated Care is committed to enriching patient experience, improving health care outcomes, increasing provider satisfaction and reducing cost of care, and will continue to work with practices to acquire the resources required to be successful in this realm.
We invite you to share your practice’s success with the population health team. Please feel free to direct any questions to Paul.Staley@uchealth.org or Austin.Bailey@uchealth.org.
Click here to learn how one patient’s life was dramatically improved by a team of integrated providers, Integrated primary care: help for both Alzheimer’s and anxiety.