For Karen Gurney, FACMPE, MGMA member, practice manager, Maine Medical Partners, Norway, Maine, switching her primary care practice to an integrated behavioral health model just made sense. Gurney’s practice made the switch eight years ago, and she wrote about the transition’s success in her fellowship paper.
Gurney and her colleagues began to contemplate bringing behavioral health to the rural practice for several reasons. Many of their patients had limited resources and often turned to their primary care physician for behavioral health issues. The physicians were not trained to manage behavioral health disorders and did not feel comfortable addressing their patients’ behavioral health needs. With a decreasing number of behavioral health specialists available to support the increasing demands, the physicians wanted to find a better solution to the issue.
Gurney and her colleagues considered finding a behavioral health specialist to be co-located in the practice’s building. But this model would be less team-oriented and didn’t allow for a significant partnership with the specialist.
So the practice decided to develop an integration model by partnering with a large behavioral health organization in the area. This allowed the behavioral health specialist to be embedded into the primary care practice. “And the reason for doing that was so that the physicians could have a behavioral health specialist to partner with and not be solely managing the patient’s behavioral health needs,” Gurney explains.
Weighing pros and cons
In her paper, Gurney outlines some of the advantages to this model:
- Offers a team-based approach
- Increases likelihood of kept appointments
- Reduces burden on primary care physicians
- Increases physician and staff satisfaction
- Improves communication among care teams
- Enhances care teams’ existing expertise
- Allows opportunity to focus on patient outcomes
On the other hand, the biggest disadvantages to developing an integration model, according to Gurney, were the costs. Operational costs needed to be built into the practice’s financial goals, she says. And the practice has to manage the operations and billing processes for the behavioral health specialist. “There needs to be prior authorizations and there needs to be support,” says Gurney. “We were not entirely prepared for that.”
Unexpected challenges
One of the biggest challenges that Gurney’s practice faced was making sure that a patient received a “warm handoff” — where the physician introduced the behavioral health specialist to the patient. At first, physicians would forget that the specialist was there.
To address this challenge, the behavioral health specialist began attending morning huddles with the physicians and clinical staff. This allowed for the specialist to be actively engaged with the care team and to collaboratively determine potential warm handoffs in the provider’s schedule, says Gurney.
Another challenge for Gurney’s team was finding a behavioral health specialist who understood the constraints of working in an integrated system. “We had to find someone who understood that they would likely be interrupted throughout the day by providers bringing patients by for warm handoffs,” she says. “It is probably the most challenging part for these therapists.”
Gurney says she brings this issue up right away during the interview process to make sure any behavioral health specialist the practice brings in understands the environment.
Providing better patient care
An important benefit of this model is that it encourages the behavioral health specialist and the primary care physician to work together to make decisions about the patient’s care, says Gurney. She emphasizes that the behavioral health specialist needs to be considered as a valued member of the team. “It just won’t work otherwise,” she says.
“I think the most important piece is that the family can see that this person is part of our team,” says Gurney. The team aspect is key for patients, because patients tend to value their physician’s recommendations. “Generally they come to their [behavioral health] appointment because they trust their physician and they are in the same setting,” says Gurney.
Overall, the benefits far outweigh the costs, Gurney says. The quality of the services provided by the behavioral health clinician was rated very good or excellent by 87.5% of providers surveyed, according to Gurney.
And she enthusiastically recommends the model to all primary care practices. “It’s an awesome model and it has benefited our patients enormously.”
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