Charting New Territory: Integrating Behavioral Health in Rural Group Practice Shay Stacer, PhD Behavioral Health Consultant Licensed Clinical Psychologist
Brief Training Bio Clinical Psychology PhD University of Colorado at Boulder Department of Psychology & Neuroscience Predoctoral Internship University of Wisconsin School of Medicine & Public Health, Madison, WI. Department of Psychiatry Postdoctoral Fellowship, Clinical Health Psychology Access Community Health Centers (FQHC) University of WI Hospital & Clinics
PCBH: the benefits of integration Population-based care model Increases access / reduces barriers In the moment collaboration and handoffs Supports patients, PCPs, and medical staff Promotes evidence-based treatments Addresses conditions that may not be in scope of traditional mental health models Allows for flexibility Reduces burden on limited resources Early identification & intervention
Coos Bay / North Bend
Mental Health Resources Psychiatry 4 psychiatric prescribers (3 adult, 1 child) OHP ONLY 1 private practice psychiatrist No Medicare 1 private practice psychiatric NP (part-time) BAH inpatient psychiatric unit (retiring psychiatrist) Mental Health Therapists 10-15 Masters level therapists (includes OHP contracted), some limitations by license type 2 identified PhD level psychologists
BH Integration in Coos Bay CCO initiated project and partnered with Adapt for development/administrative and NBMC as site for implementation = joint recruiting efforts.
Recruitment BUILDING BLOCKS Stakeholders involved & invested in the process Providers involved in recruiting ROAD BLOCKS Personality asset/liability Clinician too isolated Leadership qualities Interested in spouse, kids, and community fit Lack of loan repayment Incentives Open about both upsides and downsides Limiting license type
NBMC: what s different? (Mostly) non-centralized practice setting 15 specialties; 72 licensed providers For-profit / physician co-op Functions as group practice with some shared resources Family Medicine: 7 providers All provider offices run separate workflows with unique staff and rented space. MD/DO share call & take hospital shifts Some shift with increased CCO involvement & incentive measures
Systems Change
Implementing PCBH BUILDING BLOCKS A few very invested PCPs, including Medical Director Openness to warm handoffs STUMBLING BLOCKS The anti-integrated space A central place to set up camp Observing workflow Scheduling and admin Education of medical staff Adding work for medical staff EHR accessibility; IT staff
A typical day 9:00 alcohol dependence (FU) 10:00 PTSD / chronic pain (FU) 10:30 acute anxiety / benzo request (handoff) 11:00 smoking cessation (handoff) 11:30 phone consult for anxiety/panic 1:30 fibromyalgia (FU) 2:00 vascular dementia, family visit (FU) 2:45 acute episode psychosis (handoff) 3:00 mood/anxiety, recent SI (FU) 3:30 child with parental conflict (handoff)
Program Growth / Development BUILDING BLOCKS A very invested admin: CEO, CFO, and MD Grant funding (short-term) Enthusiasm and requests by other departments STUMBLING BLOCKS Too many cooks! (multiagency partnerships can hinder) Full clinical load reduces time and energy Technical support for data and outcomes (in progress)
Billing BUILDING BLOCKS License type and credentialing Current model not tied to revenue (future concern) STUMBLING BLOCKS Setting up backend for CPT codes (psychotherapy & HABI codes) Billing staff unfamiliar with above Complex billing process; variable payer contracts pre-auths credentialing/licensing
Funding Reimbursement for screenings & interventions CCO (Western Oregon Advanced Health) - incubator project funding - incentive measure money Commercial payer grants - Pacificsource Community Health Exchange Grant Healthcare savings (ER, admissions, adherence) Value added (reduced stress/burnout, > satisfaction)
Rural Health Career game-changer Contribution is visible ; impact is obvious Skillset and opinion valued and appreciated Increased independence, more opportunity for leadership and creativity Feel part of a community and building something
Thank You!