Monitor - October 2016

J E R E M Y K R A M E R

Adventures in Integrated Care When a new patient burst into tears in his office at Mercy Heath’s Springfield Family Medicine Clinic in Cincinnati, physician Douglas L. Hancher, MD, suspected she needed more help than she would admit, even though she denied she was suicidal.

“In the old days, we would have had to look at her insurance, check who was in her plan and seeing new patients and refer her to someone who might have been 20 miles on the other side of town,” says Hancher.

“Then it could take six weeks to
get an appointment.”
Not anymore. Thanks to
Mercy Health’s commitment to
embedding behavioral health
consultants in primary-care
practices, psychologist Leslie
Instone, PhD, was just across the
hall and able to see the patient
immediately. She discovered that
the woman had tried to kill her-
self before and had a plan to try
again soon. She sent the patient
to the psychiatric emergency
room, where she got the help she
needed.

“I would have felt terrible if I had missed someone who was suicidal and she went on to commit suicide,” says Hancher.

“Having a back-up is good.”
Stories like that are one
reason why Mercy Health—
one of the nation’s 10 largest
nonprofit health systems—is
moving aggressively to integrate
behavioral health consultants
into its family medicine, internal
medicine and pediatric clinics
in Ohio and Kentucky. The goal
is to achieve the triple aim of
better health, lower costs and
enhanced patient satisfaction,
says Martyn Whittingham, PhD,
the psychologist who launched
the initiative in 2014 as chief of
clinical integration and research
at Mercy’s Behavioral Health
Institute. ( Whittingham has
since left the organization.)

According to Mercy Health’s preliminary data, Hancher isn’t the only physician who appreciates having a behavioral health consultant as part of the team. In a survey of 100 physicians and staff members at seven Cincinnati practices involved in the integration project, participants gave almost everything at least four points on a five-point scale:

■ Access to care. Providers and practice staff, such as practice managers and care coordinators, gave an average rating of

4. 7 when asked how helpful
integration has been for patients
and how it has increased ease
of access to behavioral health
services for patients. That’s an
especially important figure given
Mercy’s mission of serving the
underserved, says Whittingham.
■ Helpfulness. The survey also
asked questions aimed specifi-
cally at providers. When asked
how helpful having a behavioral
health consultant was in terms of
providers’ ability to do their own
jobs, for example, the average
rating was 4. 5.

■ Improved work flow. Providers gave a 4. 2 average response when asked how much the integrated behavioral health model improved the work flow in their day-to-day practice. “The behavioral health consultant could have been seen as invasive or blocking work flow,” says Whittingham. “Instead, they improve work flow, even in this really early stage.”

■ Satisfaction. The 4. 7 aver-
age score for a question about
how likely providers are to
recommend behavioral health
integration to their colleagues
is a key indicator of success,
says Whittingham. “That’s the
final test,” he says, adding that
momentum is building as partic-
ipating physicians like Hancher
share their experiences with
behavioral health consultants
with their colleagues. “Physicians
are coming to us and asking,
‘When am I getting mine?’”
There are already 14
behavioral health consultants—
primarily psychologists, plus a
couple of social workers—in 24
of the system’s 150-plus prima-
ry-care clinics. Another three
are under contract but haven’t
yet started. And the system
plans to hire many more this
year. About 25 percent of the
system’s 600,000 patients already
have access to a behavioral
HOW AN
INTEGRATED
APPROACH
HELPED
MERCY
HEALTH