Primary Care Partners is a group practice in Grand Junction, CO with 21 Family Physicians and 14 Pediatricians. To better manage the behavioral needs of our patients we began collaborating at a distance with a local private counseling group, Behavioral Health and Wellness, about 12 years ago. Over time their staff and ours began to commute between offices and schedule joint patient appointments. Our partnership benefited from grant funding that promoted rapid diagnosis and treatment for ADHD. Through this project our pediatricians co-facilitated diagnostic sessions with their mental health staff.
Gauging our collaborative development using Doherty and McDaniels Five Level model, we started at a combination of Level 1, minimal collaboration, with referrals going to Behavioral Health and Wellness, along with some minimal direct communication (Level 2) before a referral visit was scheduled. This might have been a phone call or email, or faxed notes from the physician visit.
Two of us, myself as the pediatrician and one behavioral health and wellness counselor, started Level 3 (basic on- site collaboration) by traveling to and from each other's sites (7 blocks down a street), to have joint visits for certain complex patients or those who tried to "split" the physician and mental health counselor. This was time consuming and I often scheduled my visits to the mental health office on my days off; impractical but doable. In 2004 Primary Care Partners moved into a new building that allowed us to rent space to the mental health group. They now share a waiting room with our family physicians. Our proximity promotes daily shared patient care including joint visits, curbside consults, and availability for emergent evaluations in both offices. In this way we have fully implemented Level 3 (on-site collaboration) and sometimes level 4 (close collaboration in a partly integrated system)
This year we had a family physician and pediatrician complete Sandy Blount’s Primary Care Behavioral Health certificate program along with a psychologist and family therapist from the mental health office. We are also finalizing plans for a medical home that fully imbeds a few of their counselors into both our family physician and pediatrician exam room pods.
Recently we finalized a contract between the private behavioral health clinic and the state funded mental health center so that Behavioral Health and Wellness will be able to see Medicaid patients in the Pediatric office for up to 6 visits, for initial evaluation and stabilization. The requirements include a "warm" hand off by the physician, bringing the counselor into the room to meet the patient and family, and integrating the note from the counselor into our electronic health record that day.
We begin this program in a few weeks. If a client needs more that 6 mental health visits, they will be referred over to the mental health center, hopefully to a select group of clinicians ready to take the referrals without waiting time. The exciting thing about this program is that we have Medicaid patients served DIRECTLY in our office, the same way private pay or CHP (Colorado Children's Health program) clients are served.
Our physicians have continued to develop this relationship because we have benefited by many positive outcomes:
1. A patient in crisis in our office has immediate intervention with the on-site mental health staff.
2. Accurate diagnosis and medication management is much easier when supported by a thorough work-up and on-going consultation by a mental health specialist.
3. Patient satisfaction increases with the integrated therapeutic relationship of physician and mental health providers.
4. Our mental health partners save us time through continually providing updated records.
