Delaware County Medicine & Health Winter 2017 - 11

Of course, winning over the physicians and their staff
is the first obstacle to overcome. Choosing the right BH
provider is the next challenge. BH providers must embrace
the fast-paced environment. They need to successfully
navigate the challenge of winning over physicians and their
staff. They must be comfortable with managing paperwork
for new patients and attend to collecting copays each visit.
They must be dynamic, engaging 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" every day.
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 remains ever mindful of this focus. We strive
for more than a mentally healthy patient; we want to play a
key role in achieving a more medically healthy consumer.

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 follow up.
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 firsthand perspective, we continue to break through these
barriers and embrace BH's role in healthcare reform.

-------------------------------------------------------------------------References:
http://www.thenationalcouncil.org/topics/
health-integration-and-wellness
http://www.integration.samhsa.gov/
integrated-care-models/health-homes.
http://www.apa.org/health-reform/integrated-care.html

Vincent Bellwoar Ph.D is CEO/Owner of Springfield Psychological,
located in southeastern PA. Troy Brindle LCSW Director /Owner
of Springfield Psychological, co-located behavioral health services.

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

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

http://www.thenationalcouncil.org/topics/ http://www.integration.samhsa.gov/ http://www.apa.org/health-reform/integrated-care.html http://www.delcomedsoc.org

Table of Contents for the Digital Edition of Delaware County Medicine & Health Winter 2017