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Health Care Team Experience with Integration of Behavioral Health Services into a Patient-Centered Medical Home

CERISSA BLANEY, PhD

JONATHAN C. MITCHELL, PhD

MARIA CANNAROZZI, MD

Over the past two years at UCF Health, UCF's College of Medicine Practice, a major effort has been underway to introduce an integrated behavioral health (IBH) service into the existing patient-centered, collaborative environment. The impetus for this effort lies in the recognition that psychosocial dynamics often play a central role in treatment of illness. Although it is more challenging to address psychosocial needs in the primary care office, this endeavor has multiple benefits for patients and providers alike.

It is a common misconception that behavioral health care is traditional mental health treatment located in the same site as the primary care office. While addressing aspects of mental health are incorporated, behavioral health care actually focuses on a broader array of symptoms, many of which span cognitive, emotional, behavioral and physical domains. Services at UCF Health aim to increase access to care, improve health behaviors and mitigate the impact of chronic conditions. Behavioral health services also work to make traditional health care services more effective. IBH acts as a bridge to help patients obtain additional services, refine and expand our colleagues' appreciation for the behavioral components of health care, and train the next generation of behavioral health and medical providers.

Historically, this type of integration has received strong support from health care leaders but has been difficult to operationalize. The most common barriers include restrictive payment methods, confidentiality procedures, traditional provider training and ingrained practice patterns that impede collaboration. Many of the organizations that have made significant progress in this area are larger payer systems, such as the VA. Smaller organizations often face unique and shifting obstacles that make integration even more challenging, further dividing medical and behavioral health treatment.

At UCF Health, our clinical team saw an opportunity to offer IBH through partnership with the clinical psychology doctoral training program in the UCF College of Sciences. This mutually beneficial collaboration trains students to work in a rapidly growing specialty area that is both in dire need of practitioners and often overlooked by many training programs across the U.S. Training in a clinical setting best prepares our students to take on these roles in other practice locations across the country.

It is important to note that students are not the only beneficiaries in this model. The integration of behavioral health services also helps physicians provide the highest quality care possible. Primary care is typically the first stop for patients with mental health concerns, particularly those with symptoms of anxiety and depression. Often providers feel unprepared to treat these conditions or have limited time to do so, leading to a referral outside of the practice. We have been able to close this gap, and help patients to achieve great improvements in their conditions. After two years of working together as a team, the physicians say that our services help make them more effective health care providers. It allows them to maximize their time with each patient, confidently refer patients for behavioral health care, or assist patients with mental health issues that lie outside their scope of practice.

Maria Cannarozzi, M.D. is the medical director at UCF Health and an advocate for integrating behavioral health services in community primary care practices. "Our physicians have learned so much regarding how to care for patients' behavioral needs," she said. "Prior to having onsite behavioral health services, we would refer patients for psychology/psychiatry services with no knowledge of the type of care they were receiving, their progress, or if they even got the care we recommended." Dr. Cannarozzi says that through the integrated services, the physicians are co-managing illness and wellness initiatives for patients and seeing the measurable benefits such as improved blood sugar control, lower blood pressure, and weight loss.

Beyond primary care, our team has also been able to provide care for patients of specialty care providers. For these providers, having team members whose expertise includes helping patients plan, enact and sustain lifestyle changes means they can practice with greater efficiency. "As a physician, my goal is to not increase a patient's prescriptions but is to help them manage their medical condition as best as possible," said Neha Bhanusali, M.D., a rheumatologist at UCF Health. "To do that requires a lot of patient education to teach patients about all the contributing factors. The behavioral health team does an excellent job at that."

Research has demonstrated significant improvements to patients' access to and utilization of behavioral health services when they are offered on-site. Further, it has shown to produce improved patient outcomes and greater satisfaction with care. Some of these impacts can be seen through the patient's perception of care at UCF Health.

One of our staff members recently spoke with a behavioral health patient who agreed to share their story. During one brief visit with their primary care physician, the patient noted concern over severe depression. The doctor placed a referral to our team and the patient was able to be seen immediately. "At one point, I was frequently contemplating suicide" the patient said. "Just having someone to talk to helped a great deal. I'm not sure what would have happened to me if I would have been referred out- what kind of doctor I would have gotten, or if I would have even gone. I knew I needed help but didn't know where to go." This patient further reported that they are now an advocate for this team approach to health care and was especially glad to know that their case is helping to train future psychologists.

Another patient reported their experience with the behavioral health team as life changing, stating, "The behavioral health team has changed how I function in the world. I could not have done it without them. It let me focus on my weight and creating happiness in my life." The patient stated that they were often secretive about their problems, including drinking, but after discussing their concerns with their doctor, and with an introduction to the IBH services, the patient was able to work through multiple lifestyle changes.

As medicine moves forward toward values-based reimbursement, the financial value of integrated care will become more evident. Until then, quality measures related to patient outcomes, patient and provider satisfaction and cost offset will help to demonstrate the value of IBH services. Our team plans to contribute to the growing research base that demonstrates the significant benefits of integration of behavioral health in a patient-centered medical home.

Dr. Cerissa Blaney is a licensed psychologist and Director of Behavioral Health Services at UCF Health. She holds a joint appointment in the Department of Psychology and Internal Medicine.

Dr. Jonathan Mitchell is a visiting assistant professor in the Department of Psychology and a postdoctoral fellow in clinical health psychology at UCF Health.

Maria Cannarozzi is the Medical Director and a practicing physician at UCF Health and Associate Professor of Internal Medicine and Pediatrics at UCF College of Medicine.



 
 
 
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