The Primary Care Behavioral Health Model

Creating Access, Impacting Populations

Elizabeth Zeidler Schreiter, PsyD

Behavioral Health Consultant

Consulting Psychiatry Lead Access Community Health Centers

Madison, WI

Access Community Health Centers

Federally Qualified Health Center (FQHC)

3 clinic locations in Madison, WI

William T. Evue Clinic and Wingra Family Medical Clinics have Patient Centered Medical Home Certification

Medical, Dental, Pharmacy and Behavioral Health Services

Over 26,000 residents seen in 2013 (over 80,000 office visits)

Over 10,000 behavioral health visits 21%

56%

5%

17%

1%

Payor Mix

UninsuredMAMedicareCommercialOther

4% 0%

21%

7%

50%

18%

Race

AsianOther Pacific IslanderBlack or African AmericanAmerican Indian or Alaskan NativeWhiteUnknown or Patient Refused

% Primary Care8%

% Other MH7%

% Behav-ioral Need

85% Referral Completion

Rate

15%

15%

70%Treatment ObtainedNo TreatmentNo MH Tx Need

Obesity

Chronic Disease

Smokers

10-50%

When asked, patients say they prefer their care here

Primary Care “De Facto” Mental Health System

80% visit PCP in a given year

Provider Area

Exam Rooms

Hallway

Severe Depression,

Multiple somatic

complaints= PCP= BHC

Time Activity

9-9:20 Consult: Depression

9:20-9:35 Consult: Weight loss

9:45-10:10 Downtime

10:10-10:30 Consult: Panic attacks

10:30-10:50Consult: Diabetes

management

10:50-11:10 Downtime

11:10-11:30 Consult: ADHD

11:30-11:45 Consult: Parenting Issues

11:45-12:15 Notes

CURBSIDE CONSULT

SCHEDULED F/U

WARM HAND-OFF

WHAT A CONSULTANT DOES:

BRIEF CONSULTATIONS FOCUSED ON QUALITY OF LIFE AND DAILY FUNCTIONING

INCREASE SKILLS OF PROVIDERS VIA CURBSIDE CONSULTS

PROVIDE ASSISTANCE FOR MEDICATION MANAGEMENT & ADHERENCE

PHONE-BASED CONSULTATION FOR PATIENTS & ASSISTANCE WITH BEHAVIORALLY RELATED CALLS TO TRIAGE/ CALL CENTER

MANAGES OTHER RELATED SERVICES SUCH AS CARE MANAGEMENT AND CONSULTING PSYCHIATRY

EXERTS LEADERSHIP IN AREAS SUCH AS PATIENT-DOCTOR COMMUNICATION, CRISIS MANAGEMENT, STAFF RESPONSE TO DIFFICULT PATIENTS

PCBH: The Benefits of IntegrationAims to meet the primary care needs and support PCPs

De-fragments and De-stigmatizes care

Allows collaboration in the moment

Reduces psychological and social barriers

Promotes cross-education and reciprocal learning

Supports use of evidence based treatment

Provides population based care

Increases access to care

Consulting Psychiatry

Population based approach which maximizes the skills of the psychiatrist to enhance the skills of the PCP

BHC & some PCPs present patients to the psychiatrist at weekly meetings, receiving verbal and written recommendations

Psychiatrist then works with BHC to select patients on a weekly basis to see for ‘one-time’ evaluations

PCP retains prescribing role & is cross-trained in primary care psychiatry through this process (as are the BHCs)

Steps Toward Implementation-Consulting Psychiatry

Behavioral Health Consultation and Consulting Psychiatry started at Access in 2007

Administrative backing

Population care focus thus emphasis on verbal and written consultations in addition to face-to-face encounters

Psychoeducation for medical providers

Space for psychiatry consultant to work (e.g. exam room)

Finding a psychiatrist ready, willing, and able to thrive in this environment

Utilization of Behavioral health consultant to assist with triaging need and appropriate allocation of resources

Care ManagementQuarterly reviews of patients in 4 categories (depression, ADHD, pediatrics, consulting psychiatry)

Registry is populated with over 3,000 patients

Results in thousands of phone calls annually to engage patients along with cues to the medical team

PCBH In Action at Access

1 in 5 medical patients annually sees a BHC

Over 400 consulting psychiatry chart reviews and 208 face-to-face consults in 2013

Over 3000 care management chart reviews

5.5 FTE Psychologists/Social Workers; .25 FTE Consulting Psychiatrist

Train 5-10 psychology and social work trainees annually & 8 psychiatry residents annually

Research Supports PCBH

Ray-Sannerud et al. (2012) Patients significantly improved using global measure of mental health functioning two years post contact with BHC

Corso et al. (2012) Patient self-report of therapeutic alliance with BHC exceeded outpatient specialty mental health alliance

Reiss-Brennan et al. (2010) Intermountain Health System shows high patient satisfaction, improved utilization and quality outcomes

Recommended Resources

Robinson, P., & Reiter, J. (2006). Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer.

Serrano, N. (Ed.) (2014). The Implementer's Guide To Primary Care Behavioral Health. iTunes Store. Access Community Health Centers.

Access Community Health Centers (Access) Integrated Primary Care Consulting Psychiatry Toolkit 2013. Available from: http://www.hipxchange.org/Access.

Collaborative Family Healthcare Association (www.cfha.net)

Email Contact: elizabeth.zeidlerschreiter@accesshealthwi.org