The Role of TeleBehavioral Health Services
in an Integrated Behavioral
and Primary Care System
by
Marcy Rosenbaum, LCSW, CSAC
Marcy S. Rosenbaum
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Licensed Clinical Social Worker
Certified Substance Abuse Counselor
Current employment: Behavioral Health Consultant for
Southwest Virginia Community Health Systems (FQHC)
Over 5 years experience using tele-behavioral health.
Work history:
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Behavioral Health Consultant, primary care
Youth Counselor, CSB
Clinical SW, psychiatric Hospital
Drug Abuse Counselor, Job Corps Center
CPS Worker, DSS
SA Prevention Specialist, CSB: in school setting
SA Residential Tech., CSB residential treatment
Southwest Virginia Community
Healthcare Systems, Inc.
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Group of 4 non-profit federally qualified health
care centers (FQHC) and one regional dental
clinic dedicated to improving the access to
affordable, quality, comprehensive and
preventative healthcare in rural southwest
Virginia.
2011 nominee by HRSA’s (Health Resources
Services Administration) Office on Rural Health
Policy as one of the best practices in the nation
for providing integrated behavioral health/
primary care services.
Staffed with 3 behavioral health consultants.
What is Integrated Behavioral
Healthcare?
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Model of care with a systematic coordination of
physical and behavioral healthcare merged into
one service delivery system.
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PCP and Behavioral Health Consultant work
together for patient’s overall health.
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Behavioral Health Consultant offers help with
behaviors, stress, worry, emotional concerns
about physical health and other life problems
that interfere with overall wellness.
Service Delivery System
(i.e.. hospital, school, primary care office, CSB, telehealth)
Behavioral
Healthcare
Physical
Healthcare
Why provide behavioral health
services in primary care setting?
Most psychiatric treatment is provided by
non-psychiatric medical providers. 1
 70% of primary care appointments are
related to psychosocial issues. 1
 Medical and emotional/behavioral issues
are often co-occurring.
 Adults with any mental illness are more
likely than adults without a mental illness
to have chronic health conditions. 2 (cont.)
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Why provide behavioral health
services in primary care setting?
The burden of care for MH patients is
greater than current MH settings can
provide.
 Approx. 1 out of 4 patients will make it to a
behavioral health appointment referred to
a setting outside of PCP office. 3
 Less stigma and discrimination to go to
PCP office for care.
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Patient’s Integrated Service Needs
High Blood Pressure
Hepatitis
Alcoholism
Depression
PTSD
Anxiolytic Abuse
Behavioral Health Consultation at Southwest
Virginia Community Healthcare Systems, Inc.
Psychiatric assessment
 Psychotherapy
 Substance abuse counseling
 Health and Behavior
Assessment/Intervention (medical illness
specific).
 Psychiatric consults with UVA
tele-psychiatry program.
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Flow of Integrated Services
New or Returning Patient
PCP and/or nurse screen for behavioral health issue
Refer to BHC
(optional in exam
room consult
and/or appt.)
First visit to BHC for
further screening
and/or intervention
Follow-up visits to BHC
for brief interventions
YES
BH Screening
Positive
NO
Continue with
medical exam
Feedback to PCP
provided throughout the
entire process
by phone, face to face,
or electronic record.
Typical 30min. BHC session
 (5min.)
Introduction
 (5min.) Snapshot
 (5-10min.) Functional Analysis
 (5-10min.) Problem Summary/
Behavioral Change Plan
 (5min.) Charting/Feedback to PCP
Tele-Behavioral Health Services
The delivery of behavioral health services
utilizing real-time or near real-time
interactive audio/video connections.
 Does not include audio-only telephone,
electronic mail message, or fax
transmission.
 To receive insurance payment, must be at
an eligible location with an eligible
provider.
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To Bill for Tele-behavioral
Health Services:
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Eligible locations
 Federally
Qualified
Health Centers
 Rural Health Clinics
 Hospitals
 Community Mental
Health Centers
 Office of practitioner
 Skilled Nursing
Facilities
 Critical Access
Hospitals
 Renal Dialysis
Centers
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Eligible Providers
 Clinical
Psychologists
 Clinical Social Workers
 Clinical Nurse
Specialists
 Physicians
 Nurse Practitioners
 Physician Assistants
 Nurse midwives
 Registered dietitians or
nutrition professionals
Reimbursement
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April 7th, 2010, Virginia Governor passed joint
legislative action approving insurance coverage
for telemedicine services. (Not all states do.)
DMAS has recognized use of telemedicine
services since 2003.
Practitioner providing the service bills same
codes as if face-to-face and uses GT modifier.
Flow of Integrated Services using Tele-behavioral health
New or Returning Patient
PCP and/or nurse screen for behavioral health issue
Refer to BHC
(optional same day
tele-behavioral health
consult and/or appt.)
First visit by telehealth to
see BHC for
further screening
and/or intervention
Follow-up visits by
telehealth to see BHC
for brief interventions
YES
BH Screening
NO
Positive
Continue with
medical exam
Feedback to PCP
provided throughout the
entire process
by phone, face to face,
or electronic record.
Clinician use of tele-behavioral health
services within the integrated care
model:
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Schedule use of telehealth equipment with both
clinic sites.
Prepare the patient for the experience.
Use same clinical interventions as if behavioral
health visit is face-to-face.
Code with GT modifier.
Provide feedback to PCP.
Tele-psychiatry is through UVA Center for
Telehealth and is a consultative model.
Benefits Include:
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Patients have access to behavioral health
services in localities that do not have BH
providers.
Primary Care Providers have more treatment
plan intervention options for patients.
Increases patient adherence to treatment plans.
Reduced transportation costs (money and time)
for both the patients and the health care
organization.
Integrated care increases the health and
wellbeing of patients.
References
1.
2.
3.
Robinson, P.JH. &Reiter, J.T. (2007). Behavioral
Consultation and Primary Care: A Guide to Integrating
Services. New York, NY:Springer.
Substance Abuse and Mental Health Services
Administration, Center for Behavioral Health Statistics
and Quality. (April 5, 2012). The NSDUH Report:
Physical Health Conditions among Adults with Mental
Illnesses. Rockville, MD.
Strosahl, K. (2001). The integration of primary care
and behavioral health: Type II change in the era of
managed care (pp. 45-70). In N. Cummings, W.
O’Donohoe, S. Hayes & V. Follette (Eds.). Integrated
behavioral healthcare: Positioning mental health
practice with medical/surgical practice. New York:
Academic Press.
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Marcy Rosenbaum, LCSW, CSAC