Reflecting on 20 years of Implementing Integrated Behavioral Healthcare

January 26, 2024

For 20 years the AIMS Center has supported diverse healthcare organizations to integrate behavioral health services into medical settings. We’ve learned some things along the way! To celebrate our 20th Anniversary, we will be sharing our insights. Stay tuned each month throughout 2024 as we publish monthly “Lessons Learned” – beginning this month below.

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Collaborative Care Team Structure, with the Patient at the center of a triangle and the Primary Care Provider (PCP), Behavioral Health Care Manager (BHCM), and Psychiatric Consultant each in a corner. The graphic illustrates the PCP in frequent contact with the BHCM and Patient. The BHCM in frequent contact with the Patient and the Psychiatric Consultant, and the Psychiatric Consultant in infrequent contact with the PCP and Patient, and connected with the BHCM vial a Registry.

Quick Read

  • Primary Care Providers (PCP) are central to Collaborative Care (CoCM). 
  • To run a successful CoCM program you need buy-in and active participation from your PCPs. 
  • PCPs benefit from training and tools designed to aid them in their CoCM role. 

Lesson Learned #1: The Primary Care Provider

It is impossible to overstate the importance of the Primary Care Provider (PCP) in Collaborative Care (CoCM). There is a reason why they are at the apex of the care triangle (graphic above). CoCM often starts with the relationship between the patient and the PCP. Additionally, the PCP directs the care delivered by the CoCM team. When building the CoCM treatment team, implementing organizations often expend substantial time, money, and energy hiring the Behavioral Health Care Manager and Psychiatric Consultant. While this is important, organizations should ensure the PCP is a primary partner in CoCM implementation. When the PCP is an afterthought we sometimes see in implementations that struggle.  

Linchpin for Successful CoCM Implementation

When patients are identified through screening, the PCP is often best positioned to connect the patient to CoCM. They are typically the one who talks with the patient about the symptoms they are experiencing and the treatment the clinic offers. Additionally, when the clinic is billing the CoCM codes, the PCP is also the person who obtains verbal consent from the patient (except in FQHCs and RHCs where clinical staff can serve in that role).
 
A robust endorsement from the PCP is a powerful engagement tool. Most patients care what their provider thinks, and a strong recommendation to participate in Collaborative Care can set the care journey off on the right path. To do this well, the PCP needs an informative and engaging ‘elevator pitch’ about CoCM to use with patients.

Supporting PCPs in CoCM

Collaborative Care is not a referral model. The PCP remains an active member of the treatment team, prescribing medications when that is part of the treatment plan. Sometimes PCPs feel underprepared to play that role and don’t understand why the psychiatric provider doesn’t just take over the patient’s care. Or they may feel like they have everything under control and don’t need support from the psychiatric provider, but 20 years of research has shown that patients receiving treatment from their PCP alone are half as likely to improve.
 
As a key partner in building successful CoCM, PCPs benefit from orientation and preparation for their vital role. The AIMS Center provides tools and materials designed to support PCPs, including free training developed in partnership with the American Psychiatric Association.

Publication: Lessons Learned