01 Jun 2017

Working with an Accountable Care Organization

Working with an Accountable Care Organization

Arnold D. Holzman and his practice are joining forces with hundreds of physicians.

Ask Arnold D. Holzman, PhD, how he sees the future of psychology, and he lays out a vision of psychologists working side by side with physicians in accountable care organizations — groups of health-care providers who come together to provide care for a particular patient population and enjoy bonuses for keeping their patients healthy. That's why Holzman quickly agreed when an accountable care organization called the Community Medical Group asked his practice for help last year.

The idea behind the accountable care organization was to better serve patients in Connecticut's New Haven and Fairfield counties. But the several hundred physicians involved soon realized they couldn't go it alone.

"They kept coming back to the need for high-quality psychological intervention," says Holzman, co-founder and managing partner of Behavioral Health Consultants, LLC, in Hamden, Connecticut. "Many of the problems that bring individuals to physicians' offices, particularly primary-care offices, are psychologically based."

As a result, the accountable care organization turned for help to Behavioral Health Consultants, which has 11 psychologists and three master's-level clinicians on staff and subcontracts with other mental health professionals — about half of them psychologists — as needed.

Accountable care organizations are springing up in response to the Affordable Care Act, which is intended to improve care and reduce costs by encouraging reimbursement focused on the quality — not the number — of services provided. Physicians share accountability for the cost and quality of care delivered to a patient population, with insurers rewarding improved outcomes and lower costs. The organizations can not only develop their own treatment protocols but also share electronic medical records and back-office functions, such as billing and appointments.

Realizing that integrating medical and psychological services was key, Community Medical Group recruited Behavioral Health Consultants, whose providers already had relationships with many of the physicians in the organization, to provide the psychological services its patients need.

Behavioral Health Consultants and the accountable care organization are currently separate entities, but the two are discussing the possibility of co-located services. That way, says Holzman, patients will see psychologists as "a routine extension of their work with a doctor as opposed to something separate." He hopes that eventually his practice will be able to enjoy such benefits of integration as shared administrative and support services and electronic medical records, joint negotiations with payers, even profit-sharing. "This is a process that will take years," he predicts.

So far, the relationship consists of referrals.

"The problem with more traditional relationships, as many physicians have told us, is they'll often tell patients they should go see someone, but they don't know whom to refer them to," says Holzman. "And they don't know if they got there because there's no [follow-up] communication."

The physicians now tap Holzman and his colleagues when they suspect patients have emotional or behavioral problems that are impairing their health. One young man, for example, came to Holzman after tests could find no medical reason for his chest pain and other symptoms of a possible heart problem. The real issue turned out to be anxiety. "Once we reframed his symptoms as anxiety, we could approach the problem as a psychological one, not a medical one," says Holzman, who used cognitive-behavioral therapy to teach the man how to better manage the stressors in his life and the resulting anxiety.

But Holzman and his colleagues also assist patients with medical problems. In fact, they are developing the accountable care organization's protocol for treating patients who have diabetes along with depression, obesity or other problems, yet aren't following their physicians' recommendations. The protocol will lay out how referrals will be made, as well as guidelines for individual and group treatment and outcome measures so all of the providers can determine whether treatment is successful.

Holzman is also in discussions with insurers who may provide seed money for demonstration projects to show that adding psychologists' interventions keeps patients healthier. "They see our work as potentially reducing their financial exposure if patients get better sooner," he says.

He encourages other psychologists to get involved with accountable care organizations, either by developing relationships with physicians who are members of one or more organizations or by joining practices like his own that have already developed those relationships.

Holzman's background in pain management and health psychology prepared him well for working with an accountable care organization, he says. "When you're trained in pain management, communicating with physician referral sources is second nature," says Holzman, who earned a doctorate in clinical psychology from the State University of New York at Binghamton in 1981.

Such integrated care, he adds, is not only good for patients. It's also good for the bottom line. Because of the new relationship with the accountable care organization, Holzman anticipates substantial growth and expects to bring on many more clinicians and subcontractors.

"That's really the motivation here: to provide high quality service and be successful at the same time," he says.

By Rebecca A. Clay 

This article was originally published in the May 2016 Monitor on Psychology

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