Behavioral health faces a range of challenges — and top among them is access. Patients can linger on appointment waitlists for months or be caught in a referral backlog. During the limbo, patient conditions can worsen, driving them to seek crisis care in an emergency department.
For Karen McNeely, DNP, APRN-BC, chief APP service line and program director of the APP fellowship at Jacksonville, Fla.-based Baptist Health, this was unacceptable. With 270 primary care physicians, 61 offices and only 40 providers, about 50 therapists and 31 behavioral health offices, Baptist Health turned to the collaborative care model. It saw significant gains, including a 30% decrease in behavioral health referrals.
“We have way too many people needing behavioral health services and not enough providers,” she said. “Access was clearly a problem.”
As behavioral health referrals began flooding in, a large volume was for low-acuity patients whose symptoms could be managed by a primary care physician, Ms. McNeely said. This shift opened specialists’ schedules to serve higher-acuity patients with more complex needs. The system’s care model treats a majority of mild-to-moderate depression and anxiety — which account for a large portion of outpatient referrals, she said.
Traditional structures often create silos and require physicians to refer patients out. The model is built on a team of three: a primary care physician, a therapist who serves as a care coordinator and a psychiatric provider. It begins with standardized screening tools.
After completing initial assessments, a screening team determines where to place patients for the appropriate treatment, whether that’s in collaborative care or with a specialist.
“Most people would much rather be treated in the primary care office than they would going to a psychiatry office,” Ms. McNeely said. “It’s a huge patient satisfier.”
When the system first implemented the model and the standard measure known as the “third next available appointment,” wait times increased to 12 to 14 months. Three years into the implementation, specialist appointment availability dropped to seven to 14 days, depending on the specialty.
The effort began when pediatricians sought a solution for managing behavioral health conditions, such as autism and ADHD, in their daily workflows. With pediatric psychiatrists few and far between — Ms. McNeely referred to them as “unicorns” — the system turned to the model with aims to increase access to care and create financially sustainable services.
“You’re opening up a pipeline to bring in more insured patients into outpatient … that really is one of the more profitable areas for our behavioral health department,” Ms. McNeely said.
Although behavioral health is not seen as a “moneymaker,” there’s value in treating patients upstream in primary care and in specialties, whether that’s pre- and post-surgery, cardiology or neurology, she said.
“Patients who have their behavioral health needs met utilize primary care services. Overall healthcare costs go down. Treating them all in the same setting decreases the burden to the system as a whole,” Ms. McNeely said.
The system initially projected the model to become profitable in five years. Now, three years in, it has reached net zero.
