The increased interest and use of behavioral health resources since the pandemic continues to transform American healthcare. Rather than relying on referrals, practices can take a proactive step in addressing their patients’ behavioral health needs by integrating those resources into their current body of care – which can both free up clinician resources and offer much-needed assistance to established patients.
In this episode of the MGMA Insights Podcast, senior editor and host Daniel Williams chats with Dr. Jonas Bromberg, Psy.D., a clinical health psychologist and consultant at Boston’s Crossroads Health Consulting.
Dr. Bromberg has spent more than 35 years working in a variety of psychotherapy settings, including 27 years with the Department of Behavioral Medicine at Boston Children’s Hospital.
Meeting Patient Needs Through A Family Physician
During his time at Boston Children’s Hospital, Bromberg launched a program that integrated mental health clinicians into hospital-affiliated pediatric care practices across the state. This experience helped convince him of the benefits of embedding those services, rather than keeping them siloed as sometimes hard-to-access specialties.
“Primary care is one of those locations where behavioral health problems come to light,” he says. “Parents especially turn to their pediatricians first when their children are struggling with emotional issues, so it’s really an ideal venue for treating any kind of mental health-related concern, including substance use concerns. If you can get involved and care for somebody early on, it’s going to be an easier treatment.”
Bromberg recalls further seeing the value of integrated behavioral health services while working at BCH’s Boston Adult Congenital Heart Program. His systematic approach which included mental health professionals meant more comprehensive care in real time.
“They’re seeing common patients, documenting in the same electronic health record, and being able to directly consult with each other in the moment,” he says.
Helping to Overcome Patient and Practitioner Hesitancy
Unfortunately, many practitioners lack the training or the time to offer more than behavioral health referrals. Bromberg says that the move toward integrated behavioral health helps generalist practitioners become more involved in early diagnosis and avenues for treatment. Routine screenings, he says, can help provide a first line of care, just like other primary health care issues.
“A lot of physicians will take a wait-and-see approach if an issue is not really interfering with a person’s life, because they don’t know what to do. What we did in our program was provide a lot of education to physicians to help them detect mental health problems with greater accuracy, and also to be able to ask patients better questions to elicit that information.”
Providing those services at the primary care level also helps to destigmatize treatment, which can mean more patients following through with treatment plans and scheduled return visits.
“There’s a tremendous amount of stigma around going for help for mental health concerns, maybe even more about substance abuse concerns. Making it part of the culture of primary care really helps convey that (positive) message. There’s a lot of people that get referred to a mental health specialist that never follow up. If you’re only going to your doctor, it just lowers the bar and makes it easier.”
Making Integrated Care Work
Teaming up with behavioral health resources can also make financial sense from a practice management perspective, Bromberg adds. By implementing a primary care behavioral health model within their organization, practices can begin to determine if a licensed psychologist, clinical social worker or mental health practitioners will create the best fit among existing providers, as well as working out the billing angle for those enhanced services.
“Within the program that I directed for more than a decade, one of the things we made available to every practice was some billing consultation,” he says. “The person that we had used to say that it’s different, but not difficult. Many of the standard business practices that you use to make sure your revenue cycle is well managed are going to be very similar to what you do with this mental health stuff, as well.”
That means verifying insurance and coverage ahead of time, and knowing that behavioral health benefits may be carved out of a different entity than primary medical insurance. Bromberg adds that much of the benefit of integrated behavioral care can be felt in less direct ways.
“There was a managing partner in one of the practices I worked with for many years who said, ‘it doesn’t matter if we break even, because this frees up physician time. Every one of my doctors can see one or two more patients a day when they’re not bogged down.’ And patients also absolutely love having this kind of access, especially what it does in terms of creating loyalty and satisfaction.”
First Steps for Integration
Practices that are considering behavioral health integration may not know where to start, but Bromberg suggests taking a systematic approach, considering patient needs and the ways specialized staff can be integrated into practice operations.
“We often ask practices to do a time study or use the data they have to look at the most prominent concerns. That helps you think about how to structure the program you’re going to build, but also the types of clinicians you might want to look for when you go to hire.”
He also suggests considering the way behavioral health services will impact and, in most cases, amplify a practice’s overall ecosystem and communicating that as those services are added.
“This involves a bit of change in organization and structure, and it affects a lot of different people from the person that greets a patient when they walk through the door to the person who sends out the bill on the back end. We want every member of the staff to know what we’re doing, that we’re doing this for the right reasons, and to make sure everybody’s on board.”
Dr. Bromberg adds that though taking on integration may not make life easier, it makes sense for all the right reasons. "It empowers physicians, it provides higher quality care, and generates patient and provider satisfaction. So it’s worth the lift.”
Resources:
Additional Resources:
Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts.
Explore Related Content
Sponsored Solution
Tackling Administrative Burden in Post-Acute Care: A Smarter Way Forward
