Primary Care Openings Abound Now for Psychologists

By Paula Hartman-Stein, Ph.D.
November 13, 2013



Becoming behavioral care consultants (BHC) on primary care teams is no longer a future for psychologists to consider — it’s a present reality with growing opportunities.

“Integrated care is white hot, it’s smoking,” Ronald O’Donnell, Ph.D., said at a conference held here Oct. 19-20 that was co-sponsored by the Center for Applied Behavioral Health Policy at Arizona State University (ASU) and the National Alliance of Professional Psychology Providers (NAPPP).

O’Donnell is a clinical psychologist and director of the five-year-old Doctor of Behavioral Health (DBH) program at ASU.

He and other speakers from across the country said enlisting psychologists as BHCs represents a growing trend that will continue post implementation of the Affordable Care Act (ACA).

According to O’Donnell, “Lifestyle interventions and treatment can lead to cost savings, give us more leverage and raise our visibility with those who are paying for health care such as the CEOs, CFOS, actuaries and medical directors who are looking to start Accountable Care Organizations (ACOs) across the country. But very few psychologists are at the table of these discussions.”

Several speakers referred to the triple aim of the ACA: to improve the patient’s experience of care and the overall health in entire communities while lowering costs. O’Donnell gave an example of a health care plan in Arizona with a three-year plan for an ACO that underutilized behavioral health.

“They had no clue what to do. It is up to us to raise their awareness of how we can help them out, how to do population health management and return on investment analyses. The good news is that we have lots of evidence that lifestyle medicine leads to cost savings; the bad news is few are using it,” said O’Donnell.

Examples of areas where integration of behavioral health and primary care work well are diabetes, depression, anxiety, somatization, insomnia, chronic pain and opioid misuse, O’Donnell said.

Thomas Barrett, DBH, LPC, assistant vice president for operations at Adventist Behavioral Health in Rockville, Md., said the behavioral health entrepreneur of the 21st Century builds programs around disease management.

“To succeed in entrepreneurship, you have to recognize your personal strengths, weaknesses, opportunities and threats and learn what the competitors are doing,” he said. After seeing the large number of patients who are referred to weight management programs in treatment of behavioral health problems, he and his wife became franchise owners of an Anytime Fitness program.

Barrett, a graduate of the DBH program, had transferred from the doctor of psychology program at Argosy University to ASU. He praised the program for helping him hone his skills in management and business. Currently he oversees several out-patient psychiatric and geropsychiatric programs for Adventist Behavioral Health.

Dennis Freeman, Ph.D., a licensed psychologist in Tennessee and CEO of Cherokee Health Systems, a community-based provider of integrated primary care and behavioral health services, said there is more than just talk about innovation occurring in the health care market place.

“The Center for Medicare and Medicaid Services (CMS) has a Center for Innovation and they are passing out millions across the country telling provider systems they can experiment with payment such as the ACOs,” said Freeman.

The Cherokee Health System uses a behaviorally enhanced medical home model in which the behavioral health consultant is an embedded, full time member of the primary care team with one behavioral health consultant to three primary care providers.

The Behavioral Health Consultant (BHC) is flexible, has a high energy level, embraces change, is a team player and is personally interested in health and fitness, Freeman said. Required skill sets include finely honed clinical assessment skills, a strong behavioral medicine knowledge base, cognitive-behavioral skills and computer literacy.

According to Bill McFeature, Ph.D., clinical psychologist and director of Integrative Behavioral Healthcare Services for Southwest Virginia Community Health Systems, Inc., “The Behavioral Health Consultant model is the best practice for primary care. We have data to show that for 10 years.”

In both systems the BHC is a generalist who works alongside the primary care physician, rapidly screens patients using standard tools, provides behavioral consultation and brief psychotherapy and attends team meetings where as many as 20 patients are discussed in an hour. The work is fast-paced, with many interruptions and sessions with patients last between 15 and 30 minutes.

“Not every behaviorist can make it in primary care,” Freeman said. Certificate programs are popping up to teach licensed psychologists and social workers the basic skills needed to function in the world of integrated health care.

For example, Freeman is offering a Behavioral Health Consultation and Treatment Academy in late January of 2014. Other certificate programs that are ready to be launched in 2014 are through McFeature and the DBH program at ASU.

Although primary care and behavioral health have begun to work together in growing numbers of programs nationwide, the bugs are not out of the system, Freeman said. “Payment policy disincentives exist such as mental health carve outs, excessive documentation requirements, same day billing prohibitions, encounter-based reimbursement and antiquated coding requirements.”

According to Nick Cummings, Ph.D., former APA president and founder of the DBH program, “The ACA is a mish mash and one of its problems is that it was designed by people who haven’t ever seen a patient. But the barn door for integration of behavioral health care with primary care medicine is wide open and won’t go away.”

 

Paula Hartman-Stein, Ph.D., is a clinical psychologist with 30 years experience, and a member of the Medicare Evidence Advisory Committee to CMS. She offers training to psychologists in the Physicians Quality Reporting System and how to conduct early memory loss clubs and community based programs for caregivers of frail older adults. Her website is: www.centerforhealthyaging.com.
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