The Primary Care Behavioral Health
Model
Creating Access, Impacting Populations
Elizabeth Zeidler Schreiter, PsyD
Behavioral Health Consultant
Consulting Psychiatry Lead
Access Community Health Centers
Madison, WI
Access Community Health Centers
Federally Qualified Health Center (FQHC)
Race
Asian
Other Pacific Islander
Black or African American
American Indian or Alaskan Native
White
Unknown or Patient Refused
3 clinic locations in Madison, WI
William T. Evue Clinic and Wingra Family Medical Clinics
have Patient Centered Medical Home Certification
Medical, Dental, Pharmacy and Behavioral Health Services
0%
4%
18%
Over 26,000 residents seen in 2013 (over 80,000 office visits)
21%
Over 10,000 behavioral health visits
7%
Payor Mix
1%
50%
17%
21%
5%
56%
Uninsured
MA
Medicare
Commercial
Other
% Primary Care
8%
When asked,
patients say they
prefer their care here
% Other MH
7%
Chronic Disease
15%
80% visit PCP in a
given year
Obesity
15%
Smokers
70%
Treatment Obtained
No Treatment
No MH Tx Need
% Behavioral
Need
85%
Primary Care “De Facto” Mental Health System
10-50%
Referral
Completion
Rate
Provider Area
Exam Rooms
Hallway
= PCP
= BHC
Severe
Depression,
Multiple somatic
complaints
Time
Activity
9-9:20
Consult:
Depression
9:20-9:35
9:45-10:10
Consult: Weight
loss
Downtime
10:10-10:30
Consult: Panic
attacks
10:30-10:50
Consult: Diabetes
management
10:50-11:10
Downtime
11:10-11:30
Consult: ADHD
11:30-11:45
Consult: Parenting
Issues
WHAT A CONSULTANT DOES:
BRIEF CONSULTATIONS FOCUSED ON QUALITY OF
LIFE AND DAILY FUNCTIONING
INCREASE SKILLS OF PROVIDERS VIA CURBSIDE
CONSULTS
PROVIDE ASSISTANCE FOR MEDICATION
MANAGEMENT & ADHERENCE
PHONE-BASED CONSULTATION FOR PATIENTS &
ASSISTANCE WITH BEHAVIORALLY RELATED
CALLS TO TRIAGE/ CALL CENTER
MANAGES OTHER RELATED SERVICES SUCH AS
CARE MANAGEMENT AND CONSULTING
PSYCHIATRY
EXERTS LEADERSHIP IN AREAS SUCH AS
PATIENT-DOCTOR COMMUNICATION, CRISIS
MANAGEMENT, STAFF RESPONSE TO DIFFICULT
PATIENTS
CURBSIDE CONSULT
11:45-12:15
Notes
SCHEDULED F/U
WARM HAND-OFF
PCBH: The Benefits of Integration
Aims to meet the primary care needs and support PCPs
De-fragments and De-stigmatizes care
Allows collaboration in the moment
Reduces psychological and social barriers
Promotes cross-education and reciprocal learning
Supports use of evidence based treatment
Provides population based care
Increases access to care
Consulting Psychiatry
Population based approach which maximizes
the skills of the psychiatrist to enhance the
skills of the PCP
BHC & some PCPs present patients to the
psychiatrist at weekly meetings, receiving
verbal and written recommendations
Psychiatrist then works with BHC to select
patients on a weekly basis to see for ‘one-time’
evaluations
PCP retains prescribing role & is cross-trained
in primary care psychiatry through this process
(as are the BHCs)
Steps Toward ImplementationConsulting Psychiatry
Behavioral Health Consultation and Consulting Psychiatry started at Access in 2007
Administrative backing
Population care focus thus emphasis on verbal and written consultations in addition
to face-to-face encounters
Psychoeducation for medical providers
Space for psychiatry consultant to work (e.g. exam room)
Finding a psychiatrist ready, willing, and able to thrive in this environment
Utilization of Behavioral health consultant to assist with triaging need and
appropriate allocation of resources
Care Management
Quarterly reviews of patients in 4
categories (depression, ADHD,
pediatrics, consulting psychiatry)
Registry is populated with over
3,000 patients
Results in thousands of phone
calls annually to engage patients
along with cues to the medical
team
PCBH In Action at Access
1 in 5 medical patients
annually sees a BHC
Over 400 consulting psychiatry
chart reviews and 208 face-toface consults in 2013
Over 3000 care management
chart reviews
5.5 FTE Psychologists/Social
Workers; .25 FTE Consulting
Psychiatrist
Train 5-10 psychology and
social work trainees annually &
8 psychiatry residents annually
Research Supports PCBH
Ray-Sannerud et al. (2012) Patients significantly improved using global
measure of mental health functioning two years post contact with BHC
Corso et al. (2012) Patient self-report of therapeutic alliance with BHC
exceeded outpatient specialty mental health alliance
Reiss-Brennan et al. (2010) Intermountain Health System shows high
patient satisfaction, improved utilization and quality outcomes
Recommended Resources
Robinson, P., & Reiter, J. (2006). Behavioral Consultation and Primary Care: A
Guide to Integrating Services. Springer.
Serrano, N. (Ed.) (2014). The Implementer's Guide To Primary Care Behavioral
Health. iTunes Store. Access Community Health Centers.
Access Community Health Centers (Access) Integrated Primary Care Consulting
Psychiatry Toolkit 2013. Available from: http://www.hipxchange.org/Access.
Collaborative Family Healthcare Association (www.cfha.net)
Email Contact: elizabeth.zeidlerschreiter@accesshealthwi.org