1. Where & How Behavioral Health can be Integrated into the Patient-Centered Medical Home (PCMH)
*Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck.
Last updated September 2014.

2. Purpose of Slide Deck
To allow users to adapt these slides for your own presentations. Please see the notes sections for more detailed information.
This slide deck is focused on the “where” and “how” behavioral health is being integrated into the patient-centered medical home (PCMH).
You may also pull slides from Deck 1 to learn about the “why” behavioral health should be integrated into the PCMH.
This slide deck is meant for use by organizations considering transformation into a patient-centered medical home (PCMH), those already practicing patient-centered care now moving on to integration of behavioral health, and those wanting to improve their integration model. Many of the slides include basic instruction to be bypassed by experienced clinics. The presenter should consider presenting the material in three sessions based on the audience. If they are already practicing PCMH and know about integration, but are not convinced, go to section two (“Reasons Why Behavioral Health Should be Part of the PCMH”) from the first slide deck. If the clinic is already convinced to integrate, start with the models (“PCMH Integrated Behavioral Health Models“) from this slide deck.

3. Slide Deck Outline
Where Integrated Behavioral Health Models are Happening
Models for Integrating Behavioral Health in the PCMH
Coordinated Care Models
Co-Located Models
Integrated Models
Resources & Acknowledgements

4. Where Integration is Happening
This map indicates where Behavioral Health Integration activities are happening all across the country. However, this is a snapshot in time and it is not an exhaustive listing of integrated programs. Access the map, for more up-to-date listings and to learn more about these programs.
Source: AHRQ, The Academy Integration Map. Accessed September

5. Models for Integrating Behavioral Health in the PCMH5

6. Integration: An Evolving Relationship
Consultative Model
Psychiatrists sees patients in consultation in his/her office – away from primary care
Co-located Model
Psychiatrist sees patients in primary care
Collaborative Model
Psychiatrist provides caseload consultation about primary care patients; works closely with primary care providers (PCPs) and other primary care-based behavioral health providers (BHP)
Source:

7. Based on Population Needs & Required Systems
PCP-based BH provider might work for the PCP organization, a specialty BH provider, or as an individual practitioner; is competent in both mental health and substance abuse assessment and treatment.
Source: Mauer BJ (2004). Behavioral Health / Primary Care Integration: The Four Quadrant Model and Evidence-Based Practices. National Council for Community Behavioral Health.

8. Collaborative Care
Collaborative care optimizes all behavioral health resources
Source:

9. Relationship Between Medical & Behavioral Health Services (Collaboration for Same-Day Access)
Coordinated (shared costs) = Behavioral services by referral at separate location via synchronous (real-time) or asynchronous (later) information exchange
Co-Located (separate funding sources)= By referral processes at primary care location (behavioral health visit in referral office)
Integrated (same funding resource) = At primary care location (face to face with behavioral health team or by virtual synchronized telemetry)
Source: Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems & Health: 21,

10. Coordinated Care Coordinated care elements:
Appointment arrival notification
Clinical information exchange protocols
Coordinated treatment planning and/or problem solving for complex patients or as needed
Expect communication to go both ways.
Mental health clinicians are healthcare professionals who should be knowledgeable about the patient’s health issues.
Ask about the person’s health behavior goals and consider them in treatment planning.

11. Coordination Plus – Specialty Mental Health as a Consultant to Primary Care
Massachusetts Child Psychiatry Access Program
For adults in NC, Medicaid pays for time of primary care physician and psychiatrist as patient visit rates (for consultation about a patient) whether the psychiatrist has met the patient or not.
When behavioral health clinicians are working in primary care, referrals to specialty care for patients in need of longer-term work is more likely to be successful.
Source: Center for Integrated Primary Care, UMass Medical School

12. Co-Located Behavioral Health (Helps Reduce Stigma!)
Behavioral health in the same space with primary care
Involvement by referral
Separate behavioral health and medical treatment plans
Advantages
Challenges
Access greatly improved
Improved patient & provider satisfaction
Cost effective
Improved clinical outcomes
Referrals don’t show
Case-loads fill up
Slow primary care physician learning curve
Communication still difficult

13. Integrated Primary Care: Behavioral Health Consultant
Management of psychosocial aspects
of chronic and acute diseases
Application of behavioral
principles to address lifestyle
and health risk issues
Consultation and co-management in the treatment of mental disorders and psychosocial issues
Source: Center for Integrated Primary Care, UMass Medical School

14. Models of Integrated Behavioral Health
IMPACT/Diamond (Expanded Care Management): Disease based Research heritage Patient outcome evidence Care manager (SW or Psychologist) Behavioral Health Consultant: Program based Clinical heritage Cost & satisfaction evidence Behavioral health consultant
The models are beginning to converge:
Care manager does other behavioral health care and chronic illness added.
Behavioral health care management and case managers added.
Beginning disease programs.
Array of services beyond disease programs.
Source: Center for Integrated Primary Care, UMass Medical School

15. Integrated Primary Care: The IMPACT Treatment Model
Stepped protocol in primary care using antidepressant medications and/or 6-8 sessions of psychotherapy (PST-PC)
Treat to target
Collaborative care model includes:
Care manager: Depression Clinical Specialist
Patient education
Symptom and side effect tracking
Brief, structured psychotherapy: PST-PC
Consultation / weekly supervision meetings with
Primary care physician
Team psychiatrist
Source: Center for Integrated Primary Care, UMass Medical School

16. Fully Integrated Primary Care The System
Example – Cherokee Health Systems
Source: Center for Integrated Primary Care, UMass Medical School

17. Substantial Improvement in Depression (≥50% Drop on SCL-20 Depression Score from Baseline)
Source: Center for Integrated Primary Care, UMass Medical School

18. Resources & Acknowledgements18

19. Selected Resources
AHRQ Academy for Integrating Behavioral Health and Primary Care:
AIMS CENTER:
Center for Integrated Primary Care:
Collaborative Family Healthcare Association:
Evolving Models of Behavioral Health Integration in primary Care. Milbank Memorial Fund
Lexicon for Behavioral Health and Primary Care Integration. AHRQ 2013: default/files/Lexicon.pdf
National Alliance on Mental Illness. Integrating Mental Health & Pediatric Primary Care Resource Center:
SAMHSA/HRSA Center for Integrated Health Solutions: 19

20. Case Studies & Videos
Case Study: Colorado’s Advancing Care Together.
Video: AIMS Center. Daniel’s Story: An Introduction to Collaborative Care.
Webinars: University of Colorado’s Department of Family Medicine Policy Channel.
PCPCC Online Resource: Successful Examples of Integrated Models. 20

21. Acknowledgements Special thanks to: PCPCC’s Behavioral Health Group
PCPCC’s Behavioral Health Advisory Team
Alexander Blount, EdD, University of Massachusetts
Parinda Khatri, PhD, Cherokee Health Systems
Benjamin Miller, PsyD, University of Colorado
George Patrin, MD, Serendipity Alliance
CJ Peek, PhD, University of Minnesota
David Pollack, MD, Oregon Health & Science University
Erik Vanderlip, MD, University of Oklahoma
*Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck.
Last updated September 2014. 21