to data from the pediatric primary-care pilot study.
Kettlewell believes the reduction is due in part to the fact
that pediatricians now have more tools in their toolbox than
“Primary-care physicians feel lots of pressure to take
action when a parent or patient makes a request for help,”
he says. “Referring the parent to a psychologist for further
discussion and assessment represents a wise action-step, and
results in a more thorough assessment so that the right children
Geisinger is now piloting integrating psychologists and
psychology residents into adult primary care at four community
sites, Collins says. If the data show Geisinger is successful, the
hope is that other medical centers recognize the benefits of
putting psychologists on site in primary care and follow suit,
which would help improve the health of Americans nationwide,
says APA’s CEO Norman B. Anderson, PhD.
“Research clearly shows that psychological, behavioral and
social factors are key drivers of health problems seen in the pri-
mary-care settings,” Anderson says. “Incorporating psychologists
directly into these settings can help ensure that health profes-
sionals are working together to treat the whole person.”
The bottom line, Kettlewell says, is that as America attempts
to redesign health care, behavioral health services should
be expected to demonstrate cost savings, and the possibility
exists when integrated care models like the one that Geisinger
has implemented are put in place. He notes, however, that
behavioral health services continue to be an underfunded area
of health-care, and shouldn’t only be considered valuable if
adding these services into a health-care model demonstrates
“Nobody providing comprehensive behavioral health
services has a healthy return-on-investment using the fee-
for-service model,” Kettlewell says. “But there are profound
consequences to society, including added legal, educational
and unemployment expenses, because we are not adequately
addressing serious behavioral health needs.” Gianfagna also
notes that working in tandem with behavioral health experts
has helped him be a better physician. Knowing he has a
partner who is keeping up with a child’s behavioral health
needs keeps him focused on the rest of the patient’s care.
“It allows me to do what I do best, rather than playing
part pediatrician, part psychologist, part social worker,
part information gatherer, part research assistant,” he says.
“Incorporating psychology into primary care is just a natural
*Pseudonym used to protect patient privacy.
Amy Novotney is a journalist in Chicago.
This spring, APA’s Dr. Randy Phelps met with Geisinger psychologists and physician leaders, and leaders of the Geisinger Health Plan.
Back row standing, from left to right, are Eric Hill, Dr. Chris Chew, Dr. Tawnya Meadows, Dr. Laura Campbell, Dr. Erica Walles,
Ed Madalis, Richard Bitting, Dr. Thomas Graf, Dr. Cathy Schuman, Dr. Fred Bloom and Mark Basinger. Front row sitting, from left to
right, are Dr. Paul Kettlewell, Dr. Charlotte Collins, Dr. Randy Phelps, Dr. Shelley Hosterman, Dr. Heather Hoover and Dr. Nicole Quinlan.