CCMS Medicine Winter 2017 - 19
and able to connect with the widest range of patient issues
and physician personalities. Everything must be handled by
the co-located therapist as the PCP office staff are not there to
support our operations. The BH providers approach their role in
a respectful but assertive manner, looking to "prove their worth"
We quickly realized that PCP co-located services would be a
"loss leader." Fortunately, we are a large enough practice to absorb
this initial negative financial impact. Within the first few months
of co-location BH providers struggle to maintain a full schedule.
Substantial time needs to be spent consulting with physicians
on cases in order to gain their trust and respect. Although
consulting with PCPs leads to increased referrals, commercial
insurers typically do not reimburse for consultation time. Until
the payment delivery system moves away from the fee-for-service
model, integrating BH services in the medical community faces
significant financial hurdles.
Clinically, our goal is to utilize talented clinicians to provide
direct rapid assessment and treatment services within the
PCMH. Our focus shifts from "episodic acute care" to placing
a greater emphasis on overall health management of identified
patients. Within the PCMH we offer linkages to community
supports and resources as well as enhancing the coordination and
integration of both primary and behavioral healthcare services to
better meet the needs of consumers who struggle with multiple
chronic illnesses. This approach centralizes care management and
supports consumers as they work toward improved self-regulation
goals. A primary goal of this model is to improve healthcare
quality while also reducing costs. Our BH providers remain evermindful of this focus. We strive for more than a mentally healthy
patient; we want to play a key role in achieving a more medicallyhealthy consumer.
Patient feedback has been very positive overall regarding
our co-located services. Physicians appreciate that 85% of their
patients referred to our on-site BH provider show up for the
appointment (versus the 30% who make it to an outpatient BH
practice). Patients feel less stigmatized when they can access these
services in the same location where they receive medical services.
Rapid assessment and triage is more readily available and better
coordination of care is evident between the BH provider and
physician. Linkages to additional services are also easily provided
and monitored to assist with better compliance and patient
While we have attracted the attention of commercial payers
who continue to emphasize the need for BH services in the
medical setting, we find that many in southeastern PA remain
stuck in the fee-for-service system. We continue to encourage
and push insurers to think outside the box. We point to our
relationship with Aetna Behavioral Health and how they have
used financial incentives via creative CPT coding and value-based
contracting to facilitate the success of BH co-located services.
Once other payers address the need to reimburse co-located BH
providers differently, there will be easier opportunities for success.
The 2008 Federal Parity Law solidified the notion that BH
services should be on par with medical services. Placing BH
providers in medical facilities like PCP offices and PCMHs is one
way to realize the notion of parity. We still have work to do to
show the consumer and insurer how BH services are integral to
the overall health of the patient. Challenges remain in removing
unnecessary barriers to providing BH care in the medical setting.
From our first-hand perspective, we continue to break through
these barriers and embrace BH's role in healthcare reform.
Vincent Bellwoar, Ph.D., is
CEO/Owner of Springfield
Psychological, located in
Troy Brindle, LCSW, is
Director/Owner of Springfield
behavioral health services.
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