SIM practice transformation series - part 2

This is the second in a series of articles that profile the work that practice transformation organizations and practices are doing to integrate behavioral health and primary care. To read the first, please click here.

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Whole-person health has become a tagline for healthcare providers who integrate behavioral health and primary care. They recognize the need to address a patient’s head and body to achieve the best health outcomes and are changing the way they practice medicine to accommodate that approach.

Juniper Family Medicine, Grand Junction, Colo., is one of 100 practices in the Colorado State Innovation Model (SIM) that is integrating care and testing payment models to sustain those efforts. Since it started down this path, the care team is seeing positive results, including:

  • Helping a 10-year-old cope with suicidal inclinations
  • Providing counseling services for a grief-stricken patient
  • Finding handicap-accessible housing for a patient to avoid homelessness

Intervention is key

“We wanted to offer behavioral health support at the time of a doctor’s appointment, not as a separate, co-located service,” explains Kate Drackett, LCSW, case manager, Juniper Family Medicine. “Because of SIM we were able to offer that service during office visits,” she adds. “I can be there in the moment for our patients when they need us.”

And needs vary, Drackett says.

“We talk about different ways to cope with depression and what it looks like to be anxious,” she explains. “As staff understand my scope and as patients get to know me a little bit they’re more comfortable asking if they can visit,” she adds.

Team huddles help determine which team members interact with patients and when. “We may go in together or, if a provider is running behind, I go in first knowing the game plan and a provider joins whenever he is available,” she says.

Time is of the essence

Knowing when to call behavioral health specialists into appointments can be difficult because you cannot always anticipate when that support will be needed or helpful.

For example, if a diabetic patient isn’t following a provider’s recommendations, it might be “because a family member passed away and he or she is dealing with grief,” Drackett says. “That is when they [providers] need to pull me in.”

Other scenarios fit more securely into a behavioral health bucket. For example, Drackett advocated on behalf of a kid who came in with severe acne and said he was being bullied in school.

With the appropriate releases, Drackett talked with school guidance counselors and helped resolve the issue. “People normally present with things that are typically the tip of an iceberg or have some psychological component to it,” Drackett says.

The key is early identification and intervention.

Lessons learned

When introducing Drackett to patients, clinicians find that an informal approach is best.

“Team members don’t refer to me as a behavioral health person or a social worker,” she explains. “They just say, ‘This is Kate. She can help you figure out how to help you sleep a little better [as one example].’ There is still a stigma associated with [the words] behavioral health, mental health or social worker,” she adds.

However, once a primary care provider tells a patient, “This is someone who can benefit you, the trust is transferred to me,” Drackett explains. “We don’t have a strict algorithm for when to bring in a behavioral health specialist. We just don’t want to miss anybody.”

SIM will release its application for practices to join the second cohort this February. The initiative, which is funded by the Centers for Medicare & Medicaid Services, started in February 2016 and is expected to run through 2019.

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