Collaborative care in a primary care environment: Improving behavioral health access

Insight Article - April 1, 2020

Staffing Models

Population Health

Value-Based Operations

Andy Stonehouse MA
Responding to the growing need for behavioral health treatment in the United States, healthcare leaders face a unique challenge in building the best care practices for those patients within primary care.
 
These patients often have high-cost, high-utilization needs that stretch far beyond their behavioral conditions. Add to that the looming shortage of specialists, and many primary care physicians are finding themselves taking on more behavioral care responsibilities.
 
Shane Lunsford, MBA, CCT, CST, serves as administrative director, MAHEC Center for Psychiatry and Mental Wellness, and said the notion of team-based collaborative care can better address population health — providing those patients with increased access to behavioral services.
 
“Behavioral healthcare is extremely hard to get into across the country,” Lunsford said. “We’re experiencing a shortage of psychiatrists across the nation that even though there’s more psychiatry residency programs coming on board ... it’s still not going to fulfill the need. Most of the psychiatrists that are in the workforce now are heading toward retirement.”
 
Lunsford explained that collaborative care, initially developed out of an impact model for the treatment of depression, may offer some useful strategies as more of the burden for behavioral care moves into the primary care arena.

“The University of Washington did a lot of research to develop this collaborative model where we ideally have a social worker embedded in the primary care practice, working alongside the primary care physicians, whether that be a family physician, a pediatrician, and we're even seeing it in specialty practices now," Lunsford said. “That LCSW works with the primary care provider but also has contact back with the psychiatrist. In that triangle of collaboration, we’re able to pull in psychiatric consult to help the primary care provider keep the patient engaged in the treatment of their underlying conditions, as well as treat their behavioral health condition within primary care so we can keep them out of specialty care or the emergency department.

"So, long story short, we’re keeping people healthy and saving money.”

And while many practices may feel they might not have the budget or be too isolated from local psychiatric care to consider adding a Licensed Clinical Social Worker (LCSW), Lunsford knows from experience that it can be done in a sustainable manner while achieving positive outcomes for patients.

“The real financial win comes when we see that person who’s a high utilizer come back more into the norm, so they’re not utilizing as many resources," he said. "In this accountable care environment that we live in nowadays, that means a lot to larger groups or hospital-based practices.”

Hear Shane Lunsford and two MAHEC colleagues discuss their experience during the COVID-19 crisis in this MGMA Insights podcast:

About the Author

Andy Stonehouse MA
Freelance Writer and Educator Colorado

Andy Stonehouse, MA, is a Colorado-based freelance writer and educator. His professional credits include serving as editor of Employee Benefit News and a variety of financial and insurance publications, in addition to work in the recreation and transportation fields.
 

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