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When physicians refer patients to a psychologist or other behavioral health specialist, more often than not they never follow through. But by connecting behavioral health with primary care, HealthCare Partners in Torrance, CA, improved successful referrals by up to 80%.
"It’s a new system of delivering health care so you’re dealing with the biopsychosocial aspects," says James D. Slay Jr., RelD, director of behavioral health and collaborative care. The collaborative was named an Acclaim Award honoree by the American Medical Group Association in Alexandria, VA.
Behavioral health specialists, including psychiatrists, psychologists, and chemical dependency specialists, moved into primary care offices where they have staggered hours.
For example, on a Monday morning, a child psychologist may be available, and a specialist in depression may be on site in the afternoon. The specialists have formed links with family practitioners, internists, pediatricians, and OB/GYNs.
The primary care physician can introduce patients to the specialist he or she is recommending for referral, and the patient can schedule an appointment at the same office site. The physicians and specialists also can discuss cases, as necessary. Even receptionists have been trained in the collaborative care model, Slay notes.
In the case of emergency situations, such as a patient who appears suicidal or homicidal, a handoff occurs on the spot.
"The behavioral health department spends more time in primary care than it spends in the department working traditionally," he explains. "It is true coordination in real time — verbal exchange, record exchange, information exchange."
The relationships are enhanced by a monthly collaborative care forum — a lunchtime meeting, which focuses on a biopsychosocial theme such as depression or somatization (a physical ailment that has a psychological origin). Physicians and behavioral health specialists also can bring cases for discussion.
The collaboration breaks down barriers, such as stigma felt by patients who have never sought help for psychosocial issues, and it ensures that patients receive appropriate care, says Slay. "We’re reducing the anxiety and resistance of the patient. We demystify the process."
The result, he says, is higher patient and pro-vider satisfaction and better outcomes. Primary care physicians are more likely to refer patients for evaluation by behavioral health. Two-thirds of the patients seen in the collaborative care had never before had behavioral health or mental health treatment.
The program also decreases inappropriate utilization of primary care, Slay says. "By treating people appropriately, according to their real need in real time, you always have a better result."