“We can’t hire our way out of access problems.”
I have been thinking about this quote by Dennis Freeman, Ph.D., chief executive officer for Cherokee Health Systems, from The 2016 OPEN MINDS California Management and Best Practices Institute, and made in response to a question that is a conundrum in health care policy – how do we best serve consumers when the demand for behavioral health professionals is greater than the supply?
In his remarks delivered during his session, How Do You Develop & Manage An Integrated Primary Behavioral Health Practice: Lessons Learned For Executives Who Are Making It Work, he spoke to the opportunities to change the model of service, rather than the number of behavioral health professionals, in order to address these access needs.
So what is the model? Cherokee Health has evolved over the past two decades to a fully integrated primary care and behavioral health delivery model. The model is “fully integrated” from a clinical, financial, and information perspective. In the model, the consumer is at the center of the service delivery process.
To make this model work and the source of the model’s greater efficiency, is how behavioral health is provided within the consumer service workflow. Behavioral health is a consultative function – rather than a separately delivered specialty service. In the model, behavioral health professionals have to adapt to the urgent and high-volume nature of primary care. As Dr. Freeman said, “Primary care is chaos. You’re dealing with emergencies and walk-ins.” This means behavioral health professionals must see a higher number of consumers for shorter periods of time – Dr. Freeman noted that the behavioral health consultants see an average 12 consumers a day.
This process design allows Cherokee to see a high volume of consumers for both primary care and behavioral health – keeping the operation “in the black”, while also providing quality care. This is facilitated by a shared electronic health record (EHR) which provides both physical and behavioral information on the consumer. Cherokee had modified the EHR to fit its clinical model. Among the tools Cherokee has developed is a Patient Dashboard. This Dashboard lists the consumer’s care team, their future and past appointments, their health goal, hospital and emergency room admissions, their care intervention, preventive care, and health management.
Integration of primary and behavioral health isn’t easy, but when it does occur it can improve access and result in better care for consumers. For more on integration, be sure to check out, Making Integrated Service Delivery A Financial Reality: Key Models For Integration With Primary Care, Finding Funding For Integrated Service Delivery Models: The Role Of SAMHSA’s Primary Behavioral Health Care Integration Program, and Four-Step Staffing Model For Integration.
And for more on clinical decision support, join me on November 11 for The 2016 OPEN MINDS Technology & Informatics Institute, and the session, “Taking Decision Support From Concept To Practice: How To Implement Just-In-Time Clinical Decisionmaking.”