Sixteen-year-old Kyle* and his mother visited the Geisinger
Health System primary-care clinic in Pottsville, Pennsylvania,
last winter in search of treatment for Kyle’s chronic acne.
Toward the end of the visit, Kyle’s mother told the doctor,
William Gianfagna, MD, that Kyle seemed sad of late and
uninterested in some of his favorite activities. Gianfagna spoke
with Kyle for a few minutes and discovered he was depressed
and even having suicidal thoughts.
“In the past, I honestly would have tried to bail and sent him
to the emergency room,” Gianfagna says.
But times have changed at the clinic, one of more than 50
Geisinger community practice sites serving 2. 6 million patients
in central and northeastern Pennsylvania. That’s because
Geisinger is now focused on integrated care. Three years ago,
the facility was one of three pediatric community centers
selected to pilot an integrated-care program in which primary-care physicians, psychologists, nurses and other medical
professionals work together to diagnose and treat physical and
psychological health problems.
Gianfagna and other physicians learned how to screen for
depression, anxiety, attention deficit hyperactivity disorder
and several other mental health conditions, and now have a
full-time psychologist and several psychology residents down
the hall available for one-on-one and group therapy or for
consultations on a variety of mental and behavioral health
Armed with those skills, Gianfagna was able to spot the
depression and get Kyle in to see a psychologist that night.
“When I called the next morning, they already had a pretty
good plan in place to treat him,” Gianfagna says.
His eagerness and comfort level with using this mental
health screening is one of several signs that Geisinger’s
integrated approach is working, says Tawnya Meadows, PhD,
a pediatric psychologist at Geisinger’s primary-care clinic in
“Anecdotal reports show that our physicians are feeling less
stressed and more prepared because they have the screening
instruments they need and our guidance,” she says.
Preliminary data indicate that the approach is also reducing
health-care costs and improving patient care, says Paul
Kettlewell, PhD, Geisinger’s chief pediatric psychologist. The
system’s health insurance company, Geisinger Health Plan,
reports a statistically significant reduction in total pharmacy
expenses for children in the integrated-care pediatric primary-care settings compared with non-interventions sites. In
addition, the average length of treatment is shorter in integrated
care: approximately 4. 5 sessions, compared with 19 sessions at
Geisinger’s traditional behavioral health outpatient clinic.
Perhaps most important, the program is increasing access
to behavioral health services, says Shelley Hosterman, PhD, a
pediatric psychologist at the Pottsville clinic.
“I see families who have been referred by their primary-care
A reputation for excellence
physician to outpatient behavioral health clinics four, five, six
times and they have never gotten in touch with services because
there’s just too many barriers — distance, travel, making
the scheduling calls — it just involves all this extra work,”
Hosterman says. “Now, those families who really need care are
just passed down the hall to us and they start getting quality
services right away.”
Geisinger Health System serves mostly rural Pennsylvanians,
providing health-care services ranging from primary care to
complex medical subspecialties such as pediatric endocrinology
and urogynecology. Geisinger also uses a state-of-the-art
electronic medical records system to track patients throughout
its 1,000-member multi-specialty group practice, seven hospital
campuses, two research centers and dozens of community
Psychologists are part of many medical teams throughout
the system, says Charlotte Collins, PhD, chief of behavioral
medicine and adult psychology at Geisinger. They work
with many different medical populations, including those
undergoing bariatric surgery, diabetics in need of help
managing their medical regimen, cancer patients and those
experiencing chronic pain, she says.
“From the very beginning, Geisinger was a collaborative
group practice where the staff cooperated for the good of the
patient, and psychologists have always been ranked as part of
the professional staff,” Collins says.
It also helps that psychologists are part of the system’s
psychiatry division, and the two groups support and celebrate
each other’s successes, Collins says. Maintaining a cooperative
relationship with psychiatry is part of why Geisinger’s
psychologists are so well-respected, says Randy Phelps, PhD,
director of APA’s Office for Health Care Financing.
“Geisinger doesn’t have psychiatry versus psychology turf
issues,” Phelps says. “They respect each other there, and if health
care is really moving toward integrated, team-based care, that’s
Geisinger is the only hospital in the state in which
psychologists have hospital privileges. That shows the system
values them at the same level as their medical colleagues,
Kettlewell says. But getting there took a lot of small steps by
psychologists to show their worth, including offering to provide
a mental health consult in the emergency room, and then
taking the steps needed to make more systematic changes such
as getting added to the on-call schedule for after-hours ER
coverage, where decisions on hospital admission were needed.
“We’re now in the process of using this same small wins
strategy to try to change our culture so that psychologists and
other behavioral health providers are an integral part of all of
our primary care clinics,” Kettlewell says.
A natural fit
Geisinger has also reduced its pharmacy expenses, according