Patient Centered Medical Home (PCMH) and Behavioral Health Integration

PCPCC.slide.what-is-PCMHWe are honored this week to have Steven Daviss return as our guest on #hcldr. Dr. Daviss was our guest host back in February (Behavioral Health Integration and Hospital Readmissions). Below is the blog he wrote specifically for the chat on Tuesday October 14th at 8:30pm ET (for your local time click here).

ShrinkRapBook.SRD.headshot.square_400x400Blog post by Steven Daviss, MD, DFAPA (@HITshrink)

Healthcare in the United States has become so splintered and chaotic that most people would agree that our “system” is broken. People with chronic conditions, such as  may wind up having five or more practitioners — primary care, cardiology, endocrinology, psychiatry, neurology, etc — and the communication among them all is often not coordinated. This system of care is centered around each practitioner, not around the patient who must go to five different places to get care, not to mention different places for labs, tests, and medications.

The patient-centered medical home, or PCMH, is designed to be centered around the patient. This is typically a single place in which one can get much or all of their care. It is open during late hours and weekends to reduce the reliance on expensive emergency departments. You can get same-day appointments and don’t need to wait weeks to see your doctor. There are over 8000 PCMHs around the country, and each carry recognition or certification for meeting standards that all PCMHs must follow.

One of the challenges for people who have mental health and/or substance abuse problems has been the even more chaotic manner that insurance companies have handled these “behavioral health” conditions. It is common for people to have a different “carve-out” insurance company that pays for these services, with different lists of mental health practitioners, different co-pays, and different rules. The two different payers often don’t coordinate, nor do the primary care people communicate well with the mental health people. It’s a mess.

PCPCC.slide.cost-of-unmet-needs

PCMHs take a different approach to behavioral healthcare, taking responsibility for coordinating the care, making appointments, and ensuring the different practitioners communicate with each other. In fact, the latest 2014 standards from the National Council for Quality Assurance (NCQA), which has a rigorous formal recognition program for PCMHs, has added additional standards for behavioral health. Among them:

  • The practice has a process for informing patients/families about the role of the medical home and gives patients/families materials that contain information on the scope of services available within the practice including how behavioral health needs are addressed.
  • To understand the health risks and information needs of patients/families, the practice collects and regularly updates a comprehensive health assessment that includes:
    • Mental health/substance use history of patient and family.
    • Depression screening for adults and adolescents using a standardized tool.
  • The practice implements clinical decision support (e.g., point-of-care reminders) following evidence-based guidelines for a mental health or substance use disorder.
  • The practice establishes a systematic process and criteria for identifying patients who may benefit from care management, including consideration of behavioral health conditions.
  • The practice maintains agreements with behavioral healthcare providers.
  • The practice integrates behavioral healthcare providers within the practice site.

NCQA also has a program that evaluates vendors having solutions that help practices meet these standards. This Vendor Prevalidation Program has approved one behavioral health solution for PCMHs. The company, M3 Information, has a software solution called M3Clinician that makes it easy for a PCMH practice to conduct multidimensional screening for depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder (PTSD), drug and alcohol abuse, using evidence-based guidelines and clinical decision support for primary care providers managing milder forms of behavioral health conditions that do not require a specialist referral. Their consumer app, WhatsMyM3, provides an advanced self-management tool to people with behavioral health conditions. [Note: Dr. Daviss is the Chief Medical Information Officer for M3 Information.]

The #HCLDR questions for Tuesday’s chat (October 14 2014) are:

  • T1: Patient centered medical home #PCMH is WHOLE person care around pt needs. What’s PATIENT-CENTERED CARE mean to you?
  • T2: What can a #PCMH or any physician/nurse do to broach the subject of #behavioralhealth with a patient?
  • T3: How should #brainhealth/#behavioralhealth be measured/monitored in #primarycare/#PCMH care over time
  • T4: What can we do to encourage orgs to be more like #PCMH (patient-centered) to incorporate #behavioralhealth?

Why is it important to integrate behavioral health into primary care settings? 

Go to the #HCLDR chat from February titled, “Behavioral Health Integration and Hospital Readmissions,” to read the content that reviews the avoidable costs (financial, quality, and personal) associated with the status quo. DrDaviss has additional resources from that chat on his HITshrink blog.

Also, check out Dr Ann Becker-Shutte’s double-header chat from July titled, “Psychologists, Behavioral Health and Primary Care – Oh My!,” with more great information and discussion. This was a special two-hour chat with people from #HCLDR and #InnoPsy joining together to respond to eight questions.

RESOURCES
Reasons for integrating behavioral health and primary care for patient-centered medical homes. Patient Centered Primary Care Collaborative (PCPCC), 2014. [pdf]

Behavioral health resources from the PCPCC (reimbursement for depression & alcohol; slide deck)

Patient-centered medical home implementation effects on emergency room utilization: a case study. Hosp Top 92:59, 2014.

Mental health, substance abuse, and health behavior services in patient-centered medical homes. J Am Board Fam Med 27:637, 2014.

Joint principles: Integrating behavioral health care into the patient-centered medical home. Fam Syst Health 32:154, 2014.

 

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One comment

  1. […] Daviss MD DFAPA (@HITShrink) – Patient Centered Medical Home and Behavioral Health Integration – Oct […]

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