BEHAVIORAL HEALTH INTEGRATION LEARN FROM OUR MODEL AND

BEHAVIORAL HEALTH INTEGRATION LEARN FROM OUR MODEL AND MISTAKES Bethany Higa Psy. D Elizabeth Klein MD FAAFP

Introduction and your goals Who are you? What do you do? Where are you from? What do you want to learn from this presentation?

Goals and Objectives Be able to integrate Behavioral Health into your primary care clinic Discuss methods for hiring, scheduling and integrating Behaviorist. Be able to articulate 5 differences between collocated therapy and integrated behavioral health Be able to state the benefit of BHI for the providers, the patients and the medical home

Genesis of BHI at Providence @ @ Dr. Higa

Our Program Now TS 58 yo pt with COPD, depressed, referred to Dr Higa to encourage pt to stop smoking and lose weight RM 44 yo. Type 1 DM, out of control, marital issues, referred to Dr Higa to help get DM under control CB 51 yo Type 2 DM scheduled for Thyroid Bx and hysterical BM 14 yo with headaches

One example of many CK 60 yo male with DM, Obesity, Afib, Smoker who I have known for years Work on similar goals Patient feels supported I feel supported and less frustrated We are making progress, slooowly I am learning patience….

BHI Integration at Providence Family Medicine Oregon Hear from the patients, residents and staff “You have been such an incredible team” clinic patient “ I do not want to practice in a place that does not have BHI”- resident “Maybe this patient should see Dr Higa too” during pre rounding huddle- MA

Current BHI Hiring of a BHP Referral process Scheduling Availability BHI Documentation BHI Charges Collocated therapy vs BHI

Hiring a BHP Different backgrounds, training, experience Initially contracted position Pilot clinics: open to change and contained high need populations BHP were pioneers, able to advocate for self and able to work in large health system Split between 2 clinics

Who To Hire An individual with high energy, endless flexibility, strong communication skills and presence, and well honed clinical ability Psychologist or Social Worker? Do they need to be trained in BHI? What to look for in their training Important personality traits

To Contract or Not to Contract Integration is Key Streamline the role Ease of referrals to outside sources

Referral, scheduling and documentation Referral Process MD makes referral, Dr Higa thanks MD for referral, schedules pt Scheduling Use of EMR- Charts in the room, AVS, route note to PCP/ Pharm etc

Pilot Clinics High Risk Populations Clinics known for being open to change

BHI vs Collocated Therapy Collocated therapist-Uninsured, patients with Medicare or limited mental health coverage, patients who are unlikely to see psych provider outside of clinic, need in house for care coordination Handout

Collocated Therapy vs BHI • • • BHI Notes are not confidential and can be accessed by anyone using EMR BHI goals are the same as PCP, lower BP, improve glucose control, take meds as prescribed etc BHI target audience is the PCP as well as the patient 20 -40 minute appointments PROBLEM Focused BHI can meet with patients at the same time as PCP, due to same treatment goals

CHALLENGES Trouble with Integration into the system and clinic. Contracted position. Who should BHP report to? Who was/is responsible for recognition and remediation of BHP issues with patients, billing, documentation etc? BHP split between two clinics

CHALLENGES continued • • • Hiring the right person- Licensed psychologist vs Licensed clinical social worker Lack of training for BHI Personality of BHP matters- open, presence, amiability, passion, energy and efficiency How to introduce BHP to patients How to work collaboratively with BHI Availability especially since split between 2 clinics

CHALLENGES continued Billing issues Patients have liked and benefitted from BHP but have been hesitant to tell providers that the services are not being covered

Getting Medical Providers Excited About BHI “Give me a shot with this patient” Trainings and visibility Case conceptualizations Handling Difficult Patients on the Phone

Universal Accessibility Warm Hand-offs Pager Cell phone Knocks on the door BHI Openness to being interrupted

The BHP Should Make Referrals Easy Moving around throughout the clinic Huddles BHI Chart Scrubbing Streamlining sending referrals through the EMR

Participants share your experience with BHI

Groups of 4 What have you learned? What are you willing to try in your program? List 3 things you are willing to bring back to your own program. Share with the group

Conclusion BHI -Integration process BHI – Hiring, referrals, scheduling, documentation, charges, challenges We discussed 5 differences between collocated therapy and integrated behavioral health We discussed the benefits of BHI for the providers, the patients and the medical home

Hope for the future Hope for the you, your clinics, your patients and your staff BHI is being done by ordinary people in extraordinary ways and it is making a huge difference in the healing that is happening in our clinic.

At the end of the day….