Countless times Dr. Richard Lamb, a UCHealth internal medicine physician who has served the Sterling, Colo., community for 42 years, recognized an underlying behavioral health issue affecting the physical health of his patients. But it wasn’t until recently that he began to see significant results from his efforts to address these issues — and he credits that with the recent integration of a psychotherapist into his practice.
“I had patients who were not making headway with their medical problems,” Lamb said. “They weren’t able to make the changes we asked of them because of their behavioral health problems. And it was happening more than we thought.”
In 2013, UCHealth Internal Medicine in Sterling, part of Colorado Health Medical Group, UCHealth’s provider group, became part of Comprehensive Primary Care, a four-year multi-payer initiative established by the Centers for Medicare and Medicaid Services to strengthen primary care. Under the program, clinics try different care models to determine which improves patient access, cost, coordination and engagement. For example, some participants chose to integrate pharmacy services, but Sterling went a different direction.
“We started looking at integration of behavioral health,” said Clinic Manager Diane Calvert. “What would it look like if patients could be taken care of by their primary care physician but be provided integrated mental health — the two doctors working alongside each other to treat the entire patient?”
That’s where Dr. Dianna Haas came in.
Haas, a professional counselor, had a private practice in the Sterling community for 14 years and also was the mental health therapist for Valley School District in Sterling. With her community background, strong interest in mental health disorders, experience with substance abuse counseling and training in play and other cognitive behavioral therapies, she was a great fit for the clinic’s new model.
“In private practice, I would take into consideration how something like diabetes affected my patient’s mood, but I would only be treating them to improve their depression,” Haas said. “So, there would be two different people taking care of two different things. I just can’t see doing it that way anymore.”
Haas continues with her practice but has transitioned her patients into the clinic, and she leaves openings in her schedule to allow for “warm handoffs” from the providers.
“A person sees me and we do a depression screening,” Lamb said. “If we feel it’s needed, Haas is right there for me to introduce the patient to. We try to plan for a warm handoff — a quick 10 to 15 minutes for them to get acquainted and for the patient to decide if they want to follow up. It’s non-threatening and gets the patient comfortable with Haas.”
It also demonstrates the physician’s support of mental health — a key component, Haas said.
“Success depends on how the primary care physician encourages the patient to participate,” she said. “Doctors have a big impact on whether someone will accept mental health services. The warm handoff works really well, and we are trying to develop the language because it can be scary for a person, even a doctor, to say, ‘We need to talk to a mental health specialist.’ There is still that stigma. But we are seeing success.”
Despite what Lamb first predicted about the integration, he said he’s seeing bigger improvements in his patients, especially those with chronic depression, than he did before.
“To be honest, I was a bit skeptical,” he said. “I didn’t realize that we had so many people who needed mental health services. … I didn’t think we’d keep her busy, and that is just not the case. They really should have this in every clinic.”
Lamb said the new model has provided better coordination and communication between himself and Haas because of the handoff and shared electronic records.
“Before, I felt like I was sending someone into a black hole,” he said about referring a patient to mental health services. “There was a disconnect between the primary care physician and the mental health clinic. I wouldn’t know what medications my patient was on, who or when they visited, or even if they went.”
Haas see the benefits on her end, too.
“We can look at assessments, plan, and diagnosis with the same records,” she said. “We can both see how our patient is progressing and what follow-up might be needed. … There is this expectation from the patient that they know they are being taken care of.”
The clinic’s registered nurse care manager, Catina Pendleton, also plays a big role in the total care concept. One of her jobs is to follow up with patients who are most at risk to see how they are doing. She follows up with patients at the provider’s request, or after a patient’s name appears on the daily emergency room and hospitalization reports that she receives.
Until Haas arrived, Pendleton would follow up with physical health issues, such as recording the blood pressure of a patient who recently had a heart attack. But now, she keeps Haas’s patients on her radar too, checking on them — sometimes daily — to see if they need anything. She can sometimes make up to 20 calls a day, she said.
“I’m the go-between,” she said. “We are all learning this new process — the physical and mental sides — but we are treating the whole person. I think it’s a great service, and I think we picked the right model.”
UCHealth has integrated mental health into other primary care clinics as well. Though not stationed full time at the clinics, UCHealth’s Mountain Crest Behavioral Health providers are available at UCHealth Family Medicine in Windsor and in Greeley, UCHealth Cancer Center, UCHealth Internal Medicine on Snow Mesa Drive and UCHealth Internal Medicine on Prospect Avenue in Fort Collins as well as at the Horsetooth Office of Associates in Family Medicine. The A.F. Williams Family Medicine Clinic at University of Colorado Hospital has provided integrated behavioral health care since 2012.