Integration of Primary Care and Behavioral Health

Self-Management practices by both the PCP and BH providers are a must to empower our patients to learn to maintain a healthier lifestyle. These practices will hold community health centers and community mental health centers accountable to the HRSA Initiatives, SAMHSA Initiatives, and NCQA Certification processes.

Both medical and behavioral health providers learned to work together as a Primary Care Team and work on the variety of health problems presented to the team each day.

Important and different concerns revolve around the role of the DSM diagnostic system. This diagnostic system is the cornerstone of the MH system BUT it is less emphasized in PCBH model of care.

The goal of PCBH focuses on integrating the “whole being approach” and move it to the front lines of the nation’s healthcare system; hence, one plan of care (medical and behavioral health feedback) one medical chart versus charting in a mental health chart.

An integrated behavioral health provider (Mental Health Therapist or Behavioral Health Consultant) is well-positioned within primary care to increase the focus of behavior change within are patients, hence, self- management.

Clinical practice in the PCBH model relies on brief assessment and brief intervention approaches conducive to the demands of primary care.

Evidence- based practices including mindfulness, brief CBT, motivational

interviewing, relaxation and communication skills training are commonly used and adapted to use in primary care settings. These

strategies blend well in brief treatment modalities, 20 min , 30, and 50-60 min sessions.

Focus of utilizing these practices within PCBH are more restrained and geared towards smaller changes in a larger scale patient care population, i.e. primary care settings.

Co-Location of services Shared appointment systems Immediate access to services Same day appointments Chart note integration streamlined into one chart shared between medical and behavioral health provider, issues of privacy, consent, release of health

information, etc.

Schedule accessibility PCP’s can quickly access BH’s schedule for access to BH services. PCP and BH providers use the same brief assessment instruments that are

readily available, electronic or paper. Open access scheduling- first come first

served approach.

Program Staffing Team awareness of BH or BHC services meaning all primary care team members understand the role of the BH or BHC provider and how to utilize their services. PCP’s can confidently refer same day patients without stigmatizing the process

and can accurately describe the role of the BH or BHC services in providing quality healthcare.

Facilities Design “Warm-Hand Offs” from the PCP for crisis intervention services, streamlined or within the exam room. “Curbside Consultation” between PCP and BH/BHC provider prior to patient being seen or after a patient is seen by the PCP.

Access at time of need for services PCP’s comfortable in receiving advice from the BH/BHC provider regarding patients that present with behavioral health issues either face to face or electronically. The BH/BHC is seen as a core member of the MH/PC team.

The BH/BHC provider provides some type of training to PCP’s regarding their type of services.

The clinic has a defined steering group that identifies a clinical leader both medical and behavioral health.

Patients are routinely screened for behavioral health problems such as depression, anxiety, alcohol and drug problems. Patients are encouraged to access BH/BHC services for development of healthy lifestyle behaviors and to change health risk behaviors (smoking, weight, and unsafe sexual practices).

Protocol Driven referrals such as patients diagnosed with diabetes cardiovascular, and COPD/asthma, Depression, Anxiety, and other Co-occurring disorders or conditions

associated with acute distress, depression and anxiety symptomatology.

The clinic can target specific patient populations for development of clinical pathways, ie., medical conditions associated with depression/anxiety, diagnosed mental health issues, i.e., panic, depressive d/o, acute distress, and major psychiatric disorders, i.e, bipolar, schizoaffective, major depression recurrent, and generalized anxiety, etc.

Productivity standards for BH and BHC providers employed or contracted within primary care settings.

Development of Clinical Training curriculum/programs/Universities/ Colleges to prepare future BH /BHC professionals to work in primary care settings.

Creative payor mix for sustainability. Questions being generated around the use of different payment systems for

integrative care, i.e., bundled (medical visit and behavioral health visit), capitation, and proposed “Fee for Service” rates relevant to the medical home model, and bi-directional grant dollars.

LETS HAVE A DISCUSSION