Getting Patients Access to Behavioral Health Services Through Primary Care
November 1, 2022
- The primary care setting has become the de facto behavioral health care system. The question is, how do providers deliver the best care possible to their patients in a primary care environment?
- The Collaborative Care Model (CoCM) meets this challenge through tightly paired groups of highly skilled clinicians and primary care providers.
- The key to successfully integrating the CoCM into your practice relies on measurement-based standards of care and sharing a common electronic health record (EHR) between clinicians and providers.
There has always been a substantial divide between behavioral and physical health. Despite many years of research demonstrating the interrelation between the two, they are still seen as separate entities in the health care community. The continued separation of behavioral health from physical health creates barriers to accessing care for the patients who need it most.
People with chronic physical illness have a higher incidence of behavioral health disorders. Conversely, persons living with a diagnosable behavioral health condition face an increased risk of developing a chronic physical illness. As a result, patients with comorbid behavioral health issues experience higher health care costs ranging from 2.5 to 3.5 times higher than those with no diagnosed behavioral health issues. This financial burden can be blamed on increased primary care visits, emergency services, hospitalization and even hospital readmissions.
This increased strain on an already taxed system needs creative, evidence-based solutions to meet the challenges of addressing health disparities and the rising cost of health care.
Primary care providers and behavioral health
Primary care providers manage about 50% of the population needing behavioral health care — writing the bulk of prescriptions used to treat common behavioral health conditions.
Primary care providers are a natural source for accessing behavioral health care. Patients seek the advice of their primary care provider most often. There's a willingness to engage in care in this setting as the patient has already established a trusted relationship with the provider compared to a separate behavioral health setting.
Unfortunately, evidence shows that there are often challenges with adequately diagnosing and treating these patients. While these providers have the capacity to see patients, they lack the time and the specialized training necessary to make measurable improvements in behavioral health symptoms.
While it may seem like the solution is to refer a patient to a separate behavioral health care professional, the odds are low that the patient will follow through. Additionally, if the patient does follow through and is lucky enough to have insurance, finding in-network providers with appointment availability can be extremely difficult. Not to mention those who are uninsured or seeking care outside of their network are faced with increased costs. Finding an off-site, affordable, local clinician with short-term appointment availability is an extremely time-consuming task that rarely renders positive results.
As a counter to completely outsourcing separate behavioral health services, the primary care provider will frequently write a prescription and then refer the patient to follow-up at an off-site behavioral health clinic. This strategy, however, removes the provider most familiar with the patient from the care plan.
How does the primary care provider combat the roadblocks of behavioral health care? The answer: utilizing integrative care that blends behavioral and physical health into primary care settings.
Collaborative Care through Concert Health
While there are many approaches to delivering integrated care, decades of research demonstrate that the most effective method is Collaborative Care. The Collaborative Care Model (CoCM) pairs highly skilled clinicians with primary care providers to jointly support the patient. In this Model, the patient’s needs and outcomes take precedence over a rigid care plan.
A Collaborative Care partnership with Concert Health works like this:
The patient comes in for their annual exam and fills out a behavioral health screening questionnaire. During the visit, the primary care provider notes whether or not the results meet referral criteria to address potential concerns.
The provider discusses the Collaborative Care recommendation with the patient and makes a warm handoff to the Concert Health team. Within 24 to 48 hours, a member of the Concert Health team connects with the patient to coordinate their first interaction with a Collaborative Care Clinician. The Collaborative Care Clinician would then make contact with the patient to further address their symptoms.
The CoCM focuses on the symptoms the patient is experiencing rather than a diagnosis. Collaborative Care Clinicians use a variety of evidence-based psychotherapy interventions such as cognitive behavioral therapy, behavioral activation and motivational interviewing. As the Collaborative Care Clinician meets with the patient, symptom reassessment provides direction for the next steps.
Meanwhile, the Collaborative Care Clinician collaborates with the Psychiatric Consultant, and in turn, with the medical provider. The Psychiatric Consultant, while not patient-facing, works alongside the care team to ensure the patient’s medication regime is aligned with their needs.
What makes Collaborative Care work best
Collaborative Care operates through measurement-based care, intending to treat the patient to the desired target outcome. According to Concert Health’s Outcomes Report, the target-to-treat approach, through symptom monitoring and intervention adjustment, has a major impact on reducing symptom severity.
Common screening tools
Successful integration relies upon generating reliable, valid data. This involves the care team deciding on a universal screening tool to use at set intervals with patients. The behavioral health team provides insight on validated screeners, such as the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7).
Common electronic health record
The CoCM works most efficiently when the two teams use the same electronic health record (EHR). This gives the care team instantaneous access to patient health history and progress in a HIPAA-compliant fashion. Additionally, using the same EHR system allows for ease of scaling up to address population health proactively.
The Centers for Medicare and Medicaid Services (CMS) and commercial payers decision to reimburse medical providers for behavioral health services following a CoCM approach was a game-changer. Suddenly, providers had a viable revenue stream to support high-quality, whole-person care.
But understanding how to bill for these services can feel overwhelming for a practice. Working with a team that is well-versed in the ins and outs of billing for Collaborative Care reduces the administrative burden on clinical staff.
Work smarter, not harder
The CoCM improves patient outcomes through quick access to behavioral health care while supporting the medical provider in the process.
Behavioral health groups versed in the CoCM recognize this approach as the future of the field and see clinicians as core to the organization. It is critical to find a group anchored in quality and excellence to help providers make a difference in the lives of their patients.
Concert Health provides behavioral health services to primary care providers and organizations across the country. Our care is centered on Collaborative Care, an evidence-based model proven to improve behavioral health conditions, such as depression and anxiety, within primary care and women’s health settings. We can do more together. Contact us to start the conversation.