1. Embedded Behavioral Health in a Patient Centered Medical Home: Jefferson Family Medicine Associates and Delaware County Professional Services Richard C. Wender, MD Alumni Professor and Chair Department of Family & Community Medicine Thomas Jefferson University

2. Jefferson Family Medicine Associates - A Unique Practice Largest single site primary care practice in the country – 23,000 active patients who make 75,000 annual visits Integrated resident and faculty practice – 35 faculty (about 15 clinical FTE) – 28 residents (expanding to 30) – 5 CRNP’s – 2 Sports Medicine Fellows

3. JFMA: Insurance Mix

4. Behavioral Health Services – Before DCPS Partnership

5. Fragmentation – Multiple insurers each with a variety of contractual relationships – Relied largely on 800 numbers on back of card – Jefferson Psychiatry difficult to access – Disincentive to consultation

6. 2008 One of 32 Southeast Pa. practices to participate in Pennsylvania Chronic Care Commission Medical Home Pilots – Focus on diabetes care

7. On January 29, 2009, Jefferson Family Medicine earned recognition as a Level 3 Patient Centered Primary Care Medical Home from the National Center for Quality Assurance (NCQA) – The first Department of Family Medicine in the nation to earn this recognition – Fully integrated residency and faculty practice

8. August 2008 Approached by Lynne DiCaprio to consider embedded behavioral health services Designed co-location model which was implemented Jan 1, 2009 Rented Jefferson space – (Anti kickback issues must be addressed)

9. Department of Psychiatry not entirely thrilled with this plan – DCPS office is down the hall from Jefferson Psychiatry – To their credit, Jefferson Psychiatry reached out to us to improve access

10. The JFMA-DCPS-Jefferson Department of Psychiatry Model DCPS serves as initial access point for all patients and guides patients to site that can provide care

11. Referral Process JFMA clinicians complete simple referral form with patient contact information Patient signs consent for JCPS to view patient record Form is faxed to DCPS – They contact patient to schedule appointment

12. JFMA Patient Referrals Through DPCS 1/1/11 – 9/30/11 N=643

13. Keys to Success: An Option for all Insurers This is a 3-way partnership – DCPS and Department of Psychiatry have complementary contracts Department accepts Medicaid; DCPS does not, but does have a Medicare contract

14. Keys To Success: A Single Venue for all Behavioral Health Referrals DCPS serves as navigator to get patients to Jefferson, to DCPS, or to other providers for ongoing care

15. Keys to Success – Patient Acceptance Co-location makes a big difference – “Would you like to see our behavioral health counselor?” – “They work right here with us” Staying at Jefferson helps Knowing the therapists by name changes the nature of referral

16. Keys to Success – Expanding Indications Easier access within the PCMH model has allowed expansion of indications for referral – Addressing barriers to self-management

17. Keys to Success – Shared Problem Solving Meeting with your behavioral health partners to make the program better works! Now isn’t that a shocker?

18. Keys To Success – Addressing No-Show Rate Feedback from DCPS helped us be more selective with referrals – “Don’t say yes to the referral unless you are committing to keeping the appointment” – No-show has improved

19. What’s Not Working?

20. Access Challenges Co-location with an option for every patient to receive longer term care is a critical and highly valued component of the PCMH...But does not ensure adequate access or partnership

21. Nor does it address the full scope of behavioral health needs – Fully integrated behavioral health in the office with immediate access – Behavioral intervention for issues that don’t warrant referral for “counseling”