YVMA works to integrate behavioral health into primary care
August 12, 2018
The big picture, according to Yampa Valley Medical Associates (YVMA) Dr. Brian Harrington, is health care needs to change.
To be at the forefront of that transformation in terms of quality and delivery of care, as well as a change in business model, YVMA is participating in the Colorado State Innovation Model (SIM).
The focus of the initiative is to integrate behavioral health care with physical health and into primary care.
The federally funded $65 million program launched out of Gov. Hickenlooper's office in 2016 and, through its implementation across Colorado, is expected to save or avoid $126.6 million in health care costs.
YVMA and the Northwest Colorado Visiting Nurse Association are the two Routt County practices selected to participate.
What this means in Harrington's office is taking behavioral health care needs into consideration in primary care visits and having a specialist on staff with whom patients can immediately connect.
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Addressing behavioral health and physical health care needs has too long been separated, Harrington said. When "So much of what we see in primary care is intrinsically linked to behavioral health."
He said he sees at least one patient every day who also has behavioral health needs and, as a result of their work during the past few years, is now able to walk them down the hall to meet with their in-house specialist.
Following a statewide community needs assessment, SIM Director Barbara Martin said it was clear some of the greatest needs were related to mental health and substance abuse.
Through the SIM initiative, Martin described, the idea is that connecting first to those patients in primary care practices and making sure those practices are equipped to screen for and address behavioral health needs is a more effective and cost effective way to treat patients.
At YVMA, they provide services in their offices or, when needed, are able to link those patients with the resources to best address their needs.
Physical and behavioral health are interconnected, said Harrington. And "a good amount of behavioral health care can be taken care of in primary care."
If someone is dealing with a chronic health condition like diabetes or chronic pain, they may also be struggling with depression or anxiety. One can exacerbate the other and vice versa.
If someone smokes cigarettes, with obvious negative health effects, quitting requires a psychological process and change in behavior in addition to the physical act of quitting and obvious positive health effects.
Under the old model, Harrington said, patients would often be given a phone number for another doctor or facility.
When just given a referral, Martin said 50 percent of patients don't make that first appointment.
She describes the initiative as a "shift in the culture of primary care," in terms of no longer separating the health of the mind from the body.
Now, Harrington described, his patients make an immediate face-to-face connection with someone who can work directly with them, help figure out insurance, conduct follow ups or connect them to other providers.
There's also a shift underway in payment methods in the health care system, Harrington said, with reimbursement becoming more focused on outcomes.
Martin said part of the program includes an alternative payment model focused more on the value of care rather than the volume of care.
"It's not just about how we are taking care of disease," Harrington said. "It's about how we are preventing disease. And it's not just figuring out which pills to give them. It's about trying to take care of the whole patient. And behavioral health care is intrinsic to taking care of the whole patient.”