Can you sustain behavioral health integration in your practice?

Len Strazewski , Contributing News Writer

When physician private practices start to integrate behavioral health services, they need more than a behavioral health professional or two on staff. They need buy-in from diverse practices resources: IT, billing, as well as primary care physicians and behavioral health professionals who may not be accustomed to providing care in an integrated care environment.

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But without teamwork, such integrated care approaches—or behavioral health integration (BHI)—may not be sustainable for a practice, say experts who have tried and succeeded at creating a hybrid practice.

“Knowing what kind of problem you are looking to solve—that will help you determine what kind of model you use, what your outcomes are,” explained Julia Geiler, MA, technical assistance associate and policy coordinator at the Collaborative Family Healthcare Association in Chapel Hill, North Carolina.

“Making sure that everyone in your system is on board, knowing what your goals and outcomes are,” she said.

Geiler discussed the collaborative approach to integrating behavioral health care, including within private practices, during a recent webinar (registration required) that is part of the BHI Collaborative’s “Overcoming Obstacles Webinar Series,” designed to enable physicians to sustain a collaborative, integrated, whole-person and equitable approach to physical and behavioral health care in their practices.

The AMA led the establishment of the Behavioral Health Integration Collaborative, with seven other leading physician organizations, to catalyze effective and sustainable integration of behavioral and mental health care into physician practices.

Panelists explored various approaches to quality care and how physician practices, including private practices, can use communication and new research models to influence federal, state and commercial payers to increase payment for identifying successful outcomes derived from collaborative and proactive approaches to integrated care.

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Anna Ratzliff, MD, PhD, is co-director of the University of Washington Advancing Integrated Mental Health Solutions Center and moderated the session. She argued that physician practices should not underestimate the stories of their patients as a complementary way of communicating the value of their practice work when billing payers and in making their case for collaborative care rather than traditional referral.

William Beecroft, MD, medical director of behavioral health at Blue Cross and Blue Shield of Michigan, noted that physician practice income is not exclusively derived from fees for BHI services, including those related to the collaborative care model. There also are bonuses that practices can earn for positive Healthcare Effectiveness Data and Information Set scores.

Check out the BHI Collaborative’s Behavioral Health Integration Compendium, which provides health care organizations, including private practices, with a proven pathway for delivering integrated behavioral health care and ensuring they have the most recent, actionable information at their disposal.

The AMA’s behavioral health coding guide outlines key CPT codes that physician practices, including private practices, can use when administering behavioral health screening, treatment or preventive services.

A sustainable approach to behavioral health integration is also based on institutional teamwork. While that may be an old-fashioned value, Dr. Beecroft said it can still guide the collaboration with primary care physicians and behavioral health professionals.

“You really have to have the medical leads all on the same page,” he said.

However, teamwork requires commitment and, in many cases, additional staff training,

“Psychiatrists and psychotherapists do that all the time in our training, so we are used to that,” he said. “It is a different way of doing practice. But if you have worked in teams, you recognize that you start using multiple eyes to get a lot of gathered information, multiple brains that have solutions to problems.”

Too many primary care physicians in busy practices don’t have the time, working on their own, to deal with the demands of supporting patients and their behavioral health needs, he said.

”But working as a team, you can get everybody working at the top of their skill set,” Dr. Beecroft said. “It takes a team to figure that out and move forward.”

It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.

Find out more about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.