Position Your BHCs for Success in Integrated Healthcare

Ms. Levkovich describes her experiences at the Health Federation of Philadelphia and provides a perspective on the role of BHCs in Federally Qualified Health Centers. She discusses funding and reimbursement, and provides examples of capacity building, community partnerships, and workforce development in an FQHC that is primarily dedicated to providing care to underserved populations.

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Dr. Corso describes the variability of billing and coding systems by state and healthcare system.

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Dr. Khatri describes informed consent issues related to EHRs and how sharing patient information helps integrate psychologists into the healthcare team.

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Dr. Khatri describes the mission of FQHCs centered on underserved and low income populations, her experiences at Cherokee Health Systems, and opportunities for psychologists to work in integrated settings in FQHCs.

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Dr. Serrano discusses the challenges of financing integrated care including the variability by geographic locations, a fragmented financing system, specialty mental health regulations, and a lack of reimbursement for population health efforts. Dr. Serrano offers suggestions for negotiating with healthcare systems to emphasize the value of integrated care.

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Dr. McGrath describes the process of establishing an integrated primary care practice including hiring, training, facilitating team member relationships, administrative services, office structure, and working with insurers.

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Dr. Hoover discusses integrated management of respiratory diseases, including drugs commonly used to treat asthma and chronic obstructive pulmonary disease (COPD). Principles of psychological management in the integrated care setting are addressed.

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Dr. Goodie discusses assessment and psychological management of overweight and obesity conditions. Assessment instruments and principles of psychological treatment in the integrated setting are covered.

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Dr. Goodie presents an approach to the assessment and management of hypertension in the integrated care setting. Assessment and follow-up instruments and strategies are covered.

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Dr. Reiter covers various manifestations of stress in the integrated care environment and presents treatment options appropriate for the brief primary care consult.

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Dr. Goodie presents a comprehensive assessment and management package for psychological management of diabetes in the integrated care environment. Instructions for assessment, patient involvement, and follow-up are covered.

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Dr. Reiter discusses the problem of cognitive impairment in primary care, reviews the USPSTF guidelines regarding screening for cognitive impairment, and suggests strategies for intervening with cognitive impairment.

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Dr. Hoover discusses various presentations of acute and chronic pain in the integrated care environment and presents assessment and management techniques using pharmacological and non-pharmacological approaches.

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Dr. Ryee discusses the assessment and management of celiac disease and other gluten-related conditions.

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Dr. Goodie surveys the psychological management of cardiovascular disease, including hypertension, congestive heart failure and sequelae of myocardial infarction. Tools for assessment and ongoing psychological management are addressed.

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Dr. Hoover outlines pharmacological interventions and psychological management of osteo and rheumatoid arthritis in the integrated care setting, including supportive psychological approaches and drugs used to manage the disorders.

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Dr. Corso discusses interfaces between primary and behavioral healthcare and the evolution of integrated care from Engel’s biopsychosocial model. The utility of integrated behavioral care is discussed in light of population health models, cultural norms, and healthcare accessibility and costs are covered along with the 5 formal models of integration: Primary care behavioral health, co-location, medical family therapy, care management and reverse integration.

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Dr. Khatri describes the concepts of population care including measuring the health of the community instead of the individual, the triple aim, patient and family centered care, and value based payment models.

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Achieving the Triple Aim – enhanced quality of care and patient experience, plus reduced cost of care: a foundational principle of integration. Dr. Corso describes the rationale for the Triple Aim in light of the problem of exploding costs with erosion of quality of care and patient satisfaction. Also covered are efforts to place patients at the center of the care model, the importance of behavior change to enhance overall health, and how addressing behavioral health affects overall healthcare costs.

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The integration of primary care into specialty mental health care (reverse integration) is discussed. Dr. McGrath also covers the SAMHSA four quadrant model, aimed at how to ensure full health care penetrance across each quadrant (high and low mental illness, high and low medical illness). The roles of the Behavioral Health Home and Certified Community Behavioral Health Clinics are covered along with obstacles to reimbursement under these models.

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Dr. Serrano describes the foundations of the current integrated care movement, including the development of common models and terminology. He describes the three primary integrated care models – the Impact Model, SBIRT, and the Behavioral Health Consultant Model, and tools to evaluate various types of integrated care models.

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Dr. Khatri covers the role of psychologists in the primary care settings, population-based healthcare, and the four C’s of primary care (First Contact, Continuity of Care, Comprehensive Care, and Coordinated Care). She describes the pace of the primary care environment including warm handoffs from medical personnel and curbside consults with patients, and some of the mistakes psychologists frequently make in the primary care environment. She discusses collaboration with medical personnel to encourage behavior change in patients.

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Dr. Sammons discusses the medical management of obesity, including definitions and medical and surgical approaches for overweight and obesity.

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Dr. Sammons presents an overview of medications commonly used in the management of hypertension, including beta blockers, calcium channel blockers, diuretics, and angiotensin converting enzyme (ACE) inhibitors. Indications, doses, and side effects are covered.

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Dr. Sammons presents an overview of medications commonly used in the management of both Type I and Type II diabetes in the integrated care environment. Diagnosis, ADA treatment recommendations, and drug classes are discussed, including insulin, sulfonylureas, biguanides, and glucagon-like-peptide agonists.

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Dr. Sammons discusses pharmacological management of depression in the integrated care environment. Common classes of antidepressants are discussed, including specific drugs, indications, contraindications, doses, and side effects. Combined management is addressed.

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Pharmacological and combined treatment options for the management of insomnia in the integrated care environment are discussed. Specific drugs, including benzodiazepines, the Z drugs, and other sedative hypnotics are covered in detail.

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In this presentation, Dr. Sammons presents a survey of drugs used to treat common medical conditions including cardiovascular disease, obesity, and diabetes. Doses, indications, contraindications, and side effects are covered.

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Dr. Hoover discusses common anxiety presentations in the integrated care environment and covers both pharmacological and psychological management strategies for the psychological practitioner.

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The pharmacological management of attention deficit disorder is discussed. Stimulant and non-stimulant drugs are covered, including indications, contraindications, doses, side effects, and appropriate age ranges.

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Dr. Sammons outlines the Behavioral Healthcare Consultant’s role in collaborating in the prescription of psychotropic drugs.

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Dr. Hernández discusses assessment and management of a range of pediatric psychological and behavioral disorders in the integrated care environment. A special focus on children from diverse cultural backgrounds is included.

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Dr. Hernández discusses various aspects of cultural awareness, sensitivity, and competence when dealing with multicultural issues in the integrated care environment. Culturally appropriate assessment and intervention tools are covered.

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Dr. Corso discusses methods of evaluating clinical outcomes in the context of the Triple Aim. General and specific assessment instruments are discussed, along with HEDIS metrics and the PQRS. Other methods of establishing metrics that address both population health and minority population healthcare needs are addressed.

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Dr. Serrano discusses strategies for screening in the integrated care clinic. “Mindful” screening, the tagging-tracking method, and various tools useful in screening (M-CHAT, versions of the PHQ, WHODAS, and other tools). Use of the HER in tracking and implementation of the IMPACT protocol are discussed.

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Dr. McGrath re-envisions the traditional psychologist-patient relationship to fit the integrated primary care environment and pace, and provide the patient with functional stability rather than a transformative experience.

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Dr. Reiter covers various aspects of acute and chronic trauma, including assessment and management techniques appropriate for brief clinic visits.

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Dr. Reiter discusses assessment and management of substance abuse issues, including assessment devices and intervention strategies for individuals and families in the primary care environment.

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Dr. Reiter covers assessment and management of family issues in the integrated care environment. Assessment instruments, cultural issues, and brief interventions are covered.

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Dr. Hoover discusses techniques of assessment and management of depressive spectrum disorders in the integrated care environment.

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Dr. Goodie discusses assessment and psychological management of chronic insomnia. Assessment instruments and principles of psychological treatment in the integrated setting are covered.

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Dr. Reiter covers intervention to improve adherence to medical and behavioral healthcare regimens. The role of patient and provider communication, motivation, and patient access to resources, support systems and education are also covered. The use of the Valued Living Questionnaire is addressed.

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