Quantifying and Tracking Productivity for Behavioral Health Clinicians in a Primary Care Practice

Joni Haley, MSBill Gunn, Ph.D.

Aimee Valeras, Ph.D., LICSWNH Dartmouth Family Medicine Residency

Concord Hospital Family Health Center

Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.

Session #_C3c____ Friday, October 11, 2013 or Saturday, October 12, 2013

Faculty Disclosure

Please include ONE of the following statements:

We have not had any relevant financial relationships

during the past 12 months.

Objectives

• Participants will learn about the ways productivity is captured nation-wide for integrated behavioral health services within primary care.

• Participants will learn about one proposed model for capturing productivity for integrated behavioral health care in a medical setting, which parallels that of our medical provider partners.

• Participants will experience how to determine the coding levels based on different types and complexity of interactions.

Tracking BH productivity in primary care settings

• Military health services

• Fee-for-service

• Grant-funded

• State and local-funded

• Non-profit

Concord Hospital Family Health Center / NH Dartmouth Family Medicine Residency

Changing the process

• Created a “ranking” of types of integrated behavioral health interactions to parallel the levels that exist within the primary care world

• Orders were changed to reflect both amount of time spent and complexity of the interaction

Level 1 (i.e. 1 order)• 5 minutes or less• a phone call, message or email to provide a single resource• print out and in-person meeting to provide a single resource• phone call to follow-up on a resource previously provided• brief consult with provider re: resources• receiving / relaying information, including emails, from 5W

Level 2 (i.e. 2 orders)• 5-20 minutes• providing multiple resources (transportation, medication

assistance, food, finances, legal, etc) • phone or in-person discussion with patient / family regarding

no-shows, ER overutilization, POCC referral• phone or in-person discussion with patient to providing

ongoing brief support

Level 3 (i.e. 3 orders)• spending 20 minutes or more with patient / family• consultation with an MA, RN, PA, MD/DO regarding plan of

care of pt• consultation with BH Intern re: course of therapy, care

coordination, liaison between therapist and physician• coordination of a team meeting• calling collaterals (DCYF, BEAS, Riverbend) for care

coordination and communication • providing assessment to patient• involved POCC interaction

Level 4 (i.e. 4 orders)• bridging sessions• helping to resolving conflict between pt / family members

and health care team• working with providers / patients to make complex referrals

(DCYF, DV)• providing patient care (resources / crisis intervention), while

coordinating with / educating provider• providing patient care while working with other members of

team (RN, MA, PA) for care coordination• meeting with pt during Therapist’s session for care

coordination

Level 5 (i.e. 5 orders)• spending 40 minutes or more with patient / family / team• visit pt in hospital per Medicine Team’s request• coordination of immediate ER / hospitalization• Team meeting• CCC or first year observations • Encounters that involve numerous above (i.e. resource

referral, working with clinical team, educating resident, and calling collaterals)

• Nursing home / home visit • group visit (10 orders per hour)• ICAT or Collaborative Care note, for therapy intake or

otherwise

Results

• Integrated BH clinicians had less variability in their “numbers”

• Better understanding of how their role on the primary care team is utilized and relied upon

• Consistency allowed for “big picture” planning – short staffed, downturn in economy, lack of inpatient bed availability, local crises

Challenges• Many clinically significant interactions between Integrated

Behavioral Health Clinicians and medical team and/or patients take place on a less-formal basis and are not documented.

• A considerable portion of Integrated Behavioral Health Clinicians work remains under-documented and/or inconsistently documented

• No reimbursement is currently attached to Integrated Behavioral Health Clinicians interactions (outside of formal therapy), due to current billing procedures.

• Role as educator is often not documented, because the learning point is about a topic, and not a specific patient.

In summary…

• Level of integration varies widely in primarily safety-net settings

• Lack of viable and sustainable funding sources is primary obstacle to integration becoming mainstream in health care settings across US.

• Current integrated settings must make best use of consistent data collection to describe “value-added” in primary care

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!