INTEGRATION DIY - IMPROVING ACCESS TO BEHAVIORAL HEALTH SERVICES

About this series:? This is the first in a series of articles addressing issues raised in “Beating the Access Problem,” published by OPEN MINDS. Each article in our series will select one access barrier raised by the OPEN MINDS article, and describe how the DIY model of Integrated Care – developed by Third Rail Integrations - can reduce or eliminate each access barrier. In the model, the Primary Care or Family Medicine practice owns and operates the Integrated Service line and realizes the clinical benefits and revenue flow therefrom. Integrating Behavioral Health and Primary Care is far more than simply collocating Behavioral Health services in Primary Care setting. Third Rail provides expert training, consultation, and model-specific tools and algorithms to Primary Care for implementation and management of the service. This is distinct from outsourced behavioral health services which suffer from lack of comprehensiveness and care coordination and in which revenue is directed away from Primary Care, to the outsourced vendor.

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Disappointing Data:? The Open Minds article reports on a “Secret Shopper” survey, in which only “27.2% of Behavioral Health practices listed in Health Plan directories had appointments available [for new patients], 17.8% with the listed clinician and 9.4% with an alternative patient at the same practice.”

Experience makes it clear that this occurrence is widespread and is frustrating for patients and referring PCP’s alike. It often requires contacting multiple practices and receiving the same reply from each. All too often the patient and/or referring physician give up in frustration, and no treatment is received. In addition, fully 60% of patients in Primary Care panels who would benefit from Behavioral Health services are never identified, diagnosed, or treated for those conditions.

Suboptimal solutions: Primary Care often turns to one of two solutions to improve Behavioral Health Access for their patients. Either solution is largely a matter of throwing things at a wall to see what sticks. In one scenario, they hire or contract with one or more therapists (often called “Behavioral Health Consultants”). While this sort of co-location is a step in the right direction, it is only a partial solution. The number of therapist hours likely to be needed to serve the patient panel of even very small PC practices will far exceed the number of available clinician hours available with one or two clinicians. Some clinics have adopted a model in which a handful of therapy services are provided to these patients by the clinic-employed clinicians. Then, patients needing more than just a few contacts are referred outside the practice. Other practices remain unaware of the large numbers of their patients who are in need of Behavioral Health services. This creates too many cracks into which patients can fall, and often has the effect of reinstating the very ‘practice silos’ these arrangements are intended to eliminate.

In the second scenario, the PC practice might contract with an outside Behavioral Health vendor which has greater capacity. However, these vendors most likely have different organizational and clinical agenda as well as financial imperatives than does the referring practice. Experience demonstrates that the result is suboptimal coordination of care and information flow. And revenue for Behavioral Health specialty care is directed to the BH vendor rather than to the PC practice.

By contrast, with the Third Rail DIY model, the PCP practice employs or contracts with the right number of various types of Behavioral Health providers in various categories to assure that appointments are always available for new patients within five days for routine referrals and on-demand for urgent cases. Our proprietary algorithms flag for the PC practice when it is time to begin increasing BH hours of availability, and by how much. We help the practice find and recruit practitioners (psychiatrists, psychiatric NP’s, and therapists) who are a good fit for an integrated care model, and who are licensed in the PC’s state(s) of practice.

Ecologically and clinically effective delivery: The DIY model endorses use of telebehavioral health services. This modality of delivery is NOT a treatment method. The clinical services are those that are evidence-based and supported by abundant data in the Behavioral Health literature. The telehealth modality – also validated by extensive research documentation of satisfactoriness and efficacy - obviates the need to find space in the clinic for additional clinicians and appointments, and minimizes the amount of PC administrative and support staff that needs to be dedicated the these services. Our model also coordinates information flow from and between BH and PC providers, assuring that services are documented and coordinated on both the human and electronic levels.

Ecologically and clinically effective delivery: The DIY model endorses use of telebehavioral health services. This modality of delivery is NOT a treatment method. The clinical services are those that are evidence-based and supported by abundant data in the Behavioral Health literature. The telehealth modality – also validated by extensive research documentation of satisfactoriness and efficacy - obviates the need to find space in the clinic for additional clinicians and appointments, and minimizes the amount of PC administrative and support staff that needs to be dedicated the these services. Our model also coordinates information flow from and between BH and PC providers, assuring that services are documented and coordinated on both the human and electronic levels.

Business Model and Revenue:? In the DIY model, Behavioral Health clinicians are employees of, or contractors to Primary Care. The PC clinic bills for their clinical services and revenue from payors is directed to the PCC. Primary Care pays a competitive and fair market salary or hourly contacted rate to the BH clinician(s). In a later article in this series and through a significant portion of the subsequent training we will document the pertinent financials. You will see that, in addition to promoting individual and population health, the DIY model represents a substantial profit center for PC.

The right service at the right time: As will be discussed in a later article in this series, the DIY model is a stepped-care model in which services are provided by combinations of BH staff, PC staff, and other clinic administrative staff. The DIY Integrated Care service line also has considerable power in helping clinics and health plans realize the objectives of the Health Care Quadruple Aim of 1) Better care and outcomes (for both BH and other chronic medical conditions); 2) Better population health (for the entire PC patient base AND the health plan member population); 3) Lower cost (studies show, for example, cost reductions of $889 PPPM for patients with co-existing BH and other medical conditions); 4) Improved provider satisfaction and wellness.

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We can do better. An informed model of care that incorporates technology, clinical efficacy, and shared care between Primary Care and Behavioral Health - while remaining compassionate and patient-centric - can make a very substantial contribution Primary Care effectiveness and finances, and to realization of the Quadruple Aim. Subsequent articles in this series will dive into some of the details and nuances of how various elements of the model address those objectives.

In the interim, we thank you for your interest and invite you to contact Phil Hirsch, PhD – CEO - for further information (206.491.2796; [email protected]) or James DiGiorgio – President, Applied Knowledge - to arrange a Webinar or Discovery Meeting (931-451-7758; [email protected]).

THIRD RAIL - POWERING INTEGRATION

Albert Einstein