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NEXT STEPS: CLINICAL PATHWAYS
BHCs receive supervision from an experienced LCSW monthly and as needed and also meet with a consulting psychiatrist monthly to discuss challenging patients. In addition, BHCs gather as a group quarterly for a day designed to add to their clinical skills and to develop camaraderie and learn from each other.
Our BHI program faces two important directions in the next few years. One is to develop clinical pathways targeting highpriority populations that might benefit from behavioral health input. We are starting with people with common behavioral health conditions comorbid with common chronic physical health conditions, as well as those with chronic pain and substance abuse problems. Other target populations will be identified over time.
Operational: Successful implementation of BHI depends on attention to important operational details before the integrated BHC arrives, during the early days of integration, and ongoing for years. Our approach has been to work with practice operational staff throughout the process, with the goal of maintaining shared responsibility for the success and growth of the BHI program. Before integration starts, our job is to help practice staff understand what the BHC can (and can’t) do, and what the BHC’s role will be in the practice. Some staff members will have to learn specifics about billing and scheduling for behavioral health services. The integrated BHC may need to be credentialed with one or more health plans. Once the integrated BHC begins working in the practice, some of the operational focus has to be on helping the BHC with the clinical model of focused treatment, which may be different from how they are used to providing care. Primary care operational leadership continues to be closely involved in monitoring and troubleshooting implementation. In each region, program leadership meets monthly with regional leaders and practice leaders to review program performance.
We are also increasingly being asked to integrate behavioral health services in specialty settings. This partly overlaps with the focus on common chronic illnesses, with diabetes and heart failure being two of the populations we are being asked to serve in specialty settings. These initiatives recognize that people with serious illnesses experience psychosocial issues and might benefit from behavioral health services. Behavioral health integration is an important and feasible approach to being ready for a pay-for-value world. Attention to the clinical, operational, and financial aspects of implementation will help you to do so successfully. And successful implementation will lead to better care experiences and better outcomes. The AHRQ Playbook — a resource that can be helpful to your organization, if you are thinking about or working on integrating behavioral health into ambulatory care settings— will soon be available on the AHRQ Academy for Integrating Behavioral Health and Primary Care website. This interactive set of tools will guide your organization through the process of planning and operationalizing integration6. o
These monthly meetings sometimes include review of data about the program. Available data about productivity, access and show rate has been limited. We are working on developing a broader dashboard of measures to understand how the integrated BHCs are being used and what impact they are having on the value of care. Our goal is to add measures of clinical outcomes, experience of care (for patients and providers/staff) and cost of care.
Neil Korsen, MD, MSc, is Medical Director, Behavioral Health Integration Program, at MaineHealth. He will present a CAPG Annual Conference breakout session, “Integrating Behavioral Health into Primary Care,” on Saturday, June 18, at 2:15 pm.
Financial: Integrated BHCs are hired by Maine Behavioral Healthcare, a regional behavioral health organization that is part of MaineHealth. They are then contracted to practices for,in most cases, 20 to 40 hours per week. The practices bill for services, assisted by our staff, with the goal of collecting enough to cover their costs. We charge the practice organization a management fee for our role in implementing and supporting the BHI service.
2. Kathol, deGruy, and Rollman. Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes. Annals of Family Medicine 2014: pp.172-175.
Most billing uses mental health codes. Some providers use health and behavior codes, which are specifically designed to use when a BHC is providing treatment for the behavioral or emotional aspects of physical health problems. Unfortunately, there are limits that vary by health plan on which types of clinicians can bill these codes. That makes the use of these otherwise important codes challenging for primary care organizations. 44 l CAPG HEALTH
Summer 2016
References 1. Peek, CJ and the National Integration Academy Council—”Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus,” AHRQ Publication No. 13 – IP001-EF. Rockville, MD,Agency for Healthcare Research and Quality. 2013. Available at: http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf
3. Butler, Kane, McAlpine et al. Integration of Mental Health/Substance Abuse and Primary Care. NO. 173 (Prepared by the Minnesota Evidencebased Practice Center under Contract No. 290-02-0009) AHRQ Publication No. 09-E003. Rockville, MD. Agency for Healthcare Research and Quality, October 2008. 4. Melek, Norris, and Paulus. Economic Impact of Integrated MedicalBehavioral Healthcare: Implications for Psychiatry. Prepared for the American Psychiatric Association by Milliman, Inc. Accessed at https://www.psychiatry. org/psychiatrists/practice/professional-interests/integrated-care . 5. Peek and Henrich. Building a Collaborative Healthcare Organization: From idea to invention to innovation. Family Systems Medicine 1995: Volume 13, pp.327-342. 6. https://integrationacademy.ahrq.gov/