The Power of Integrated Behavioral Health

Garry Bliss, Senior Director Government Programs & Communications?

Up to 70% of physician visits are for issues with a behavioral health component.

Integrating Behavioral Health into Primary Care: A Technology Assessment (Final Report June 2, 2015 - Institute for Clinical and Economic Review)

The head is connected to the body.

This statement may seem self-evident, but for too long healthcare operated as if this were not true.

However, it is now widely recognized that only when you treat the whole person – their medical well-being and their mental health together – will you achieve positive outcomes, particularly with higher-need patients.?

Systems of care have a unique advantage when it comes to helping primary care providers address the dynamic interaction between physical health and mental health.

At CPGRI, we have pursued a multi-faceted strategy that touches every level of care, supports all patients, and ensures every provider has the resources and support they need to fully meet the integrated needs of their patients.

CPGRI’s Multi-Faceted IBH Strategy

Training & Professional Development

Through a partnership with the Care Transformation Collaborative, we hold up to four interactive training sessions a year covering topics such as a multi-part introduction to behavioral health, a deep dive into the comorbidity of depression and anxiety with chronic medical conditions, intimate partner violence and elder abuse, and more. For the past two years, our team has earned CEUs for these sessions.

Our Medicaid team receives a monthly education session on a BH or SUD topic of their choosing.

Consultation/Integrated Case Review

Our care management team also benefits from the regular participation of BH providers in standing clinical review meetings.

In these meeting, nurse care managers and social workers discuss specific patient cases they are working on. Sometimes they know they are also addressing a BH and/or SUD issue with a patient. There are also times when the consulting clinician alerts providers to the potential presence of BH/SUD issues. This can be a treatment- and outcome-changing insight.??

Rapid Evaluation & Referral

Primary care practices see patients with BH and SUD issues every day. ?

Maybe a patient comes in presenting with physical symptoms – loss of appetite, weight loss, poor sleep. A physical evaluation yields nothing. ?The provider suspects there is a BH issue but does not know the right level or mode of care.?

To address this, we created a Rapid Evaluation and Referral program with a comprehensive behavioral provider. Upon receiving patient consent, a provider makes a referral via email, secure fax, or within the EHR. The patient is contacted within four hours or the next day. They are schedule for a comprehensive evaluation – in-person or via tele-health – often within three days.?

The patient is diagnosed, prescribed medication when appropriate, and referred to the right level and mode of care. The referring provider receives a comprehensive report.?

Last year alone, more than 250 referrals were made, and more than 90% of those who enroll in service maintain their engagement.

Peer Recovery Partnership

Through a partnership with East Bay Community Action Program (EBCAP), we can refer members of our Medicaid AE for substance use peer support services. Because this population can be a challenge to engage, EBCAP committed to make at least seven outreach attempts under our agreement with them.

To date, every person who has agreed to meet with a peer has kept that appointment.

Integrated Transitions of Care

After analyzing some data, we identified that the readmission rate for BH and SUD admissions was significantly higher than for medical admissions. Next highest was the readmission rate for medical admissions among patients with a moderate to serious BH or SUD diagnosis.

We had a solid foundation with a Transitions of Care (TOC) program with a proven record of success, but we needed to add new expertise, new services. Working with Elwyn Adult Behavioral Health Care, we created an Integrated TOC model where patients served by our existing TOC team receive supplementary service by BH professionals at Elwyn.?

IBH Practice Facilitation

The most important part of our strategy – and the most impactful – has been our investment in expanding integrated behavioral health at primary care practices.

With all expenses covered by CPGRI, practices receive one-on-one consultation and professional guidance from an integrated behavioral health content expert and leader, Dr. Kristin David. Dr. David has 5 years’ experience delivering direct care as an IBH clinician in a busy PCMH-certified primary care office. Dr. David has also helped multiple practices receive IBH distinction through NCQA.

By the end of the process, each practice has developed a unique IBH solution for their primary care practice. This includes workflows, billing codes to maximize revenue, processes for identify and referring patients for IBH care, and more. Practices also receive assistance recruiting, interviewing, hiring, and on-boarding an IBH clinician with trainings for current staff to maximize the team approach to IBH.

One dozen practices have participated or are currently participating in IBH Practice Facilitation.

Interested in Learning More?

If you would like to learn more about how being a part of CPGRI can give you new tools to provide comprehensive care to your patients, reach out to:

?

Danielle Andrade?????????????????????????????????????????????????????????????Martin Kerzer, DO

VP Population Health Contracting and Network?????????????Senior Medical Director

[email protected]?????????????????????[email protected]