Virtual Behavioral Health Integration and Primary Care Applications

Letting Innovation Improve Primary Care for Patients

The human body is a cohesive network of tissue, nerves, and organs, all working together to maintain survival. Currently, the US healthcare system supports a somewhat siloed approach to maintenance and treatment for the human body and any physical maladies that present.  This approach results in treating specific systems and symptoms.  At times, the interconnected nature of the systems is overlooked.  If nerves or hormones malfunction, implying mental health issues, these maladies are more likely to go ignored; however, behavioral conditions are the leading cause of patient non-compliance for most patient populations.  The current healthcare system can be and needs to be reconfigured to treat the human body, in its entirety, through behavioral health integration (BHI).

Behavioral Health Integration

BHI is an integration of behavioral healthcare into the primary care field.  The idea of the integration is simple – primary care physicians assess the physical symptoms of their patients while evaluating the patients’ mental well-being.  The physician conducts a thorough history and physical and prescribes a comprehensive treatment plan addressing both physical and mental symptoms.  BHI is overwhelmingly beneficial for the patient, and the primary care provider, but a stalled implementation is problematic.

According to the New England Journal of Medicine, widespread adoption of BHI is limited.   Clinicians are educated on BHI but lack a “clear business model for incorporating these services into their practice” (NJEM, 2017).  Barriers to a universal business model are diverse – lack of uniform insurance, provider cost, availability, and patient compliance.  The data supports that constructing a BHI plan, even at the localized primary care level, results in overwhelming positive patient outcomes.  A study conducted in Belgium found that out of 2,316 patients –5.4% initially presented for mental health issues, but 42.5% had mental health issues detected, highlighting the value of providing access to behavioral services in primary care (PubMed.gov, 2004).

Virtual Behavioral Health Integration

Positive patient outcomes are a valid reason for using a BHI system, but implementation requires resources – many of which a primary care office cannot provide.  With suicide rates increasing at an estimated 43,000 people per year, the pressure is mounting for the medical community to address mental healthcare, whether insurance can maintain pace or not (NYUMC, 2017).  Virtual BHI seeks to fill this gap on the provider-level. Adopting a virtual behavioral health integration platform introduces the opportunity to provide these services to patients, regardless of location and ability, addressing the core problem, lack of access.

Carolinas Healthcare System (CHS) in North Carolina is one healthcare system currently using a Virtual BHI system.  CHS adopted telepsychiatry in 2011 to service their Emergency Departments, after recognizing an influx of mental health patients visiting the ED for care.  By providing 24/7 telemedicine services, they complete 900 – 1,000 psychiatric evaluations monthly, with 800 – 900 warranting inpatient services.

The successful adoption led them to add virtual services to their primary care practices in 2014.  CHS hires mental health professionals to work alongside psychiatrists and primary care physicians utilizing virtual call centers, video assessments, and telephone outreach.  This virtual trifecta provides services all over North Carolina patients, expanding the offered services and reducing the number of areas inaccessible to medical care (AHA, 2018).

Virtual care workflows increase productivity and efficiency when incorporating BHI into a primary care system, leading to increased revenue sources, as lack of patients requiring these services is not an issue.  A 2015 study conducted by NYU Langone Medical Center estimates that over 8.3 million people suffer from serious psychological distress and would benefit from mental health services in a multi-faceted capacity.  Significant numbers of these patients are not avoiding treatment, but lack access to a behavioral specialist, and only have time or resources for a primary care physician (NYUMC, 2017).

A Virtual Solution That Works

Even with plenty of patients, rampant need, and proven outcomes – primary care offices are still businesses.  As such, many providers must plan the use of their limited or regulated resources.  The solution lies in leveraging a virtual BHI resource such as VisuWell, which provides a virtual platform for confidential, compliant behavioral health services and an existing network of behavioral providers.

The WeCounsel provider network is a crucial piece of the platform and its value is demonstrated when providers cannot be brought in-house for traditional care.  Telebehavioral integration truly brings value when the slow nature of in-person evaluations and referrals simply proves to be too costly, while creating a poor patient experience.  Primary care providers can use the VisuWell platform to work collaboratively with a credentialed and verified behavioral healthcare provider.  Additionally, an on-demand referral can easily be facilitated for practices that opt for a less collaborative approach to BHI.

Reimbursement & Revenue

Reimbursement is a top concern for physician groups, and it is worth noting that the landscape is quickly changing to support BHI and telehealth.  CMS began supporting BHI in January of 2017 with 4 new reimbursement codes that include revenue opportunities for :

  • Administering Behavioral Assessments
  • Delivering psychiatric collaborative care through a behavioral care manager
  • Behavioral healthcare planning
  • Facilitation and coordination of behavioral health
  • Maintaining a continuous relationship with a designated behavioral specialist
  • Depending on the allotted time and service provided CMS reimbursement ranges from $48 for 20 minutes of services, to $140 for up to 70 minutes of services, making BHI implementation profitable for CMS.

Summary

Virtual BHI is a means of leveraging technology to expand access to behavioral care in primary care settings.  Mental healthcare is an overlooked and underfunded medical focus, with plenty of conditions treatable and manageable upon diagnosed.  The stigma surrounding mental health care is lessening, and Virtual Integrators, like VisuWell, is a way to increase patient compliance and quality metrics. Incorporating virtual technology puts primary care in line with disruptive innovations and optimizes care for patients.

The barriers and benefits to Virtual BHI are well-known, as not all insurance companies cover mental health services, and healthcare providers must adopt protocols to adapt; however, as represented by CMS new and proposed reimbursement models, revenue opportunities already exist.  With the documented improvement in outcomes related to collaborative care, Virtual BHI is the next step in assisting physicians in maximizing efficiency and providing the care every patient deserves.

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