Experts Make Case, Share Strategies for Primary Care Behavioral Health Model

Behavioral health providers have long advocated for the primary care behavioral health (PCBH) model as a way to improve access to services, cut costs and deliver better health outcomes for patients.

And yet, widespread adoption within the industry has yet to be seen.

Experts discussed the conundrum and shared tips to make the process more seamless during a webinar hosted Wednesday by the National Council for Behavioral Health and the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The way that we have tried to implement this model in our particular bidirectional setting is by really thinking of the behavioral health consultant as providing three key features,” Clarissa Aguilar, a behavioral health consultant and director of psychology and training for the San Antonio, Texas-based Center for Health Care Services said during the webinar.

Those include consulting with doctors, gathering information and creating change for the patient, she told webinar attendees.

The Center for Health Care Services is a community health care organization providing integrated mental health and primary care services in various locations in and around San Antonio. It employs the PCBH model.

Generally, the PCBH model embeds behavioral health clinicians into primary care practices in an effort to deliver more holistic care to patients.

By addressing patients’ behavioral health needs on the front end in primary care settings, one hope is that it reduces the burden on back end for behavioral health providers, who are already seeing a demand for services that often outpaces supply.

“A lot of [addressing behavioral health] is actually happening in primary care,” Andrew Philip, a senior director of clinical and population health of New York City-based Primary Care Development Corporation (PCDC), said during the webinar.

Often times, that’s by necessity, Philip explained. But the PCBH model allows primary care providers to take a more intentional approach.

“If you just look at the sheer numbers, for example, most antidepressant prescriptions are written in primary care versus behavioral health,” he added. “There’s a kind of a fundamental access issue.”

The non-profit PCDC has provided community investment in various primary care practices and providers in 43 states and the District of Columbia, as well as Puerto Rico and the U.S. Virgin Islands. PCDC also employs the PCBH model.

“When we’re talking about integrating a behavioral health consultant into primary care behavioral health, … the idea is that they’re a member of the team,” Philip said. “They’re not working necessarily as an isolated practitioner, but they’re working alongside the [PCP] and the rest of the primary care team.”

Philip recommends making sure the behavioral health clinician’s office is centrally located within a primary care facility to encourage collaboration with doctors and engagement with patients.

He also encourages primary care doctors to consult with behavioral health clinicians on patients — in addition to having those clinicians see patients directly — as a way to save time and maximize the number of patients whose behavioral health needs can be addressed.

There are some reimbursement options to pay for the PCBH model, but financial and clinical benefits don’t stop there, panelists explained. In the end, the model leads to better outcomes for patients.

“One of the goals with primary care behavioral health is to not add to the burden or the workload of the primary care team, because we already know that’s… quite high,” said Philip. “The goal is to increase efficiency with our presence.”