24 May 2017

Primary-Care Practices Appreciate Having Integrated Behavioral Health Consultants

Primary-Care Practices Appreciate Having Integrated Behavioral Health Consultants
When a new patient burst into tears in his office at Mercy Heath's Springfield Family Medicine Clinic in Cincinnati, physician Douglas L. Hancher, MD, suspected she needed more help than she would admit, even though she denied she was suicidal.

"In the old days, we would have had to look at her insurance, check who was in her plan and seeing new patients and refer her to someone who might have been 20 miles on the other side of town," says Hancher. "Then it could take six weeks to get an appointment."

Not anymore. Thanks to Mercy Health's commitment to embedding behavioral health consultants in primary-care practices, psychologist Leslie Instone, PhD, was just across the hall and able to see the patient immediately. She discovered that the woman had tried to kill herself before and had a plan to try again soon. She sent the patient to the psychiatric emergency room, where she got the help she needed.

"I would have felt terrible if I had missed someone who was suicidal and she went on to commit suicide," says Hancher. "Having a back-up is good."

Stories like that are one reason why Mercy Health—one of the nation's 10 largest nonprofit health systems—is moving aggressively to integrate behavioral health consultants into its family medicine, internal medicine and pediatric clinics in Ohio and Kentucky. The goal is to achieve the triple aim of better health, lower costs and enhanced patient satisfaction, says Martyn Whittingham, PhD, the psychologist who launched the initiative in 2014 as chief of clinical integration and research at Mercy's Behavioral Health Institute. (Whittingham has since left the organization.)

According to Mercy Health's preliminary data, Hancher isn't the only physician who appreciates having a behavioral health consultant as part of the team. In a survey of 100 physicians and staff members at seven Cincinnati practices involved in the integration project, participants gave almost everything at least four points on a five-point scale:

  • Access to care. Providers and practice staff, such as practice managers and care coordinators, gave an average rating of 4.7 when asked how helpful integration has been for patients and how it has increased ease of access to behavioral health services for patients. That's an especially important figure given Mercy's mission of serving the underserved, says Whittingham.
  • Helpfulness. The survey also asked questions aimed specifically at providers. When asked how helpful having a behavioral health consultant was in terms of providers' ability to do their own jobs, for example, the average rating was 4.5.
  • Improved work flow. Providers gave a 4.2 average response when asked how much the integrated behavioral health model improved the work flow in their day-to-day practice. "The behavioral health consultant could have been seen as invasive or blocking work flow," says Whittingham. "Instead, they improve work flow, even in this really early stage."
  • Satisfaction. The 4.7 average score for a question about how likely providers are to recommend behavioral health integration to their colleagues is a key indicator of success, says Whittingham. "That's the final test," he says, adding that momentum is building as participating physicians like Hancher share their experiences with behavioral health consultants with their colleagues. "Physicians are coming to us and asking, 'When am I getting mine?'"

There are already 14 behavioral health consultants—primarily psychologists, plus a couple of social workers—in 24 of the system's 150-plus primary-care clinics. Another three are under contract but haven't yet started. And the system plans to hire many more this year. About 25 percent of the system's 600,000 patients already have access to a behavioral health consultant. It has been a challenge to find enough psychologists ready and willing to work in these fast-paced, integrated settings. "There aren't enough people trained in primary-care integration," says Whittingham, who earned his doctorate in counseling psychology from Indiana University in 2006. "I've visited multiple universities and told deans, 'If you train them, we have positions they can apply for.'"

To make up for that lack of preparation, Mercy Health has developed an intensive training regimen for new hires. In addition to watching training videos, new behavioral health consultants "shadow" more seasoned consultants in their own practices for a week. Then they flip positions, moving into their new settings with their colleagues alongside them to supervise them for a week.

On the medical side, physicians are discovering that behavioral health consultants can help not just with psychological problems but with physical problems, too, including medication adherence, exercise and smoking cessation, says Mbonu N. Ikezuagu, MD, MBA, the attending physician for the internal medicine residency program at Mercy St. Vincent Medical Center in Toledo.

"Integrating a behavioral health consultant into our office has moved us closer to achieving our goal of delivering amazing patient care," says Ikezuagu, adding that both the attending physicians and 36 residents use the service on a daily basis. "This is the wave of the future."

By Rebecca A. Clay

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