An efficient workflow that creates a seamless experience for patients and care team members is essential to successfully integrating behavioral health care into your practice.

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During a recent Behavioral Health Integration (BHI) Collaborative webinar that the AMA hosted, a psychiatrist and a family physician shared how to integrate behavioral health care in a way that supports efficiency and care quality without disrupting practice operations.

“When we think about workflows for integrated care, there are a lot of very specific tasks. Sometimes people don’t really think about how much it takes to run this through your clinic,” psychiatrist Lori Raney, MD, principal with Health Management Associates in Denver, said during the webinar. “The devil is in the details here and in the minutia … An effective implementation really requires the staff to sit down and really go through this together.”

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Integrate behavioral health into your practice, step by step

To help physicians create practices that are able to help treat the whole patient, the AMA established the BHI Collaborative with seven other leading medical associations. The collaborative assists physicians in overcoming obstacles to integrating behavioral and mental health care into primary care practices to help reach more patients. The goal is for the patient to receive mental health care within the primary care office, whether from a psychiatrist, other mental health professional or a combination by using a team-based care approach.

Identifying and diagnosing patients. How do you identify the patients who are appropriate for integrated care and who is responsible for making the diagnosis? Screening tools are often administered before the physician sees the patient and the practice should decide how that will be accomplished. For example, it can be done on an iPad in the waiting room or by a nurse in the exam room. Who will do that? And if the screen is positive, who is going to talk to that patient about it?

Engaging a patient in an integrated care program. The patient didn’t come in for behavioral health care. They came in for diabetes management or another reason and now you want to talk about depression. The goal of the primary care provider is to figure out how to connect the patient to the behavioral health care specialist. How will you do that?

Providing evidence-based treatment. Once a patient is engaged, you need to provide evidence-based treatment. What will that look like? Brief intervention? Psychotherapy? Psychopharmacology?

Systematic follow up, treatment adjustment and relapse prevention. Now that a patient is being treated, there needs to be some form of systematic follow up to know when and where and how to adjust the treatment. And once a patient is out of the program, how will you prevent relapse or detect it early if and when relapse occurs?

Communication, care coordination and referrals. If integrated care isn’t suitable for a particular patient—for example if they are in a manic phase of bipolar disorder or if they have schizophrenia—you need to have figured out, ideally beforehand, how you will get them to the higher level of care that they need.

Systematic case review and psychiatric consultation. As you begin to follow these patients, how do you review them? How do you make treatment adjustments? What does that look like?

Program oversight and quality improvement. Once your practice has data, how do you incorporate and use it in your quality improvement program to know if integrated care is or isn’t working and what needs to be done to improve?

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How to sustain behavioral health care in primary care practice

Family physician Jennifer Thomas, MD, medical director of integrated care at Morris Hospital in Illinois, explained in the webinar how they implemented an effective workflow to integrate behavioral health care.

She emphasized the importance of defining key tasks and roles and having everyone participate in mapping out the workflows to cover all of the details and help people buy-in to the plan.

The webinar is part of the BHI Collaborative’s Overcoming Obstacles webinar series that was designed to help physicians offer mental and behavioral health services in their practices.

The Behavioral Health Integration (BHI) Compendium, offers a one-stop online collection of resources from eight national physician organizations designed to help you on your integrated health care journey no matter where you are on the path.

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