Bringing mental health care into your PCP

It’s not such a crazy idea!

Although much has been made in the news of the lack of mental health care in many managed care insurance plans, the trend toward integrating and providing a continuum of care is leading many primary care practices to bring behavioral health inside their walls.

One such example is Methodist Medical Group (MMG), a 100-physician practice in Indianapolis. Nicola Scott, RN, MHA, director of behavioral health network services at MMG, says the idea to put behavioral health specialists into primary practice locations came from one of her provid ers. "We already had our own separate behavioral health practice in our own location," she explains. "This was just a way to bring the services to the primary care practice."

Initially, one of the three psychologists met with the primary care practices in six locations and told them he and his colleagues could offer the service a half day per week in their practices. "It was a way to reach patients who otherwise either wouldn’t seek the care or who were in crisis and really needed the care."

Growing popularity

A year later, the program has expanded to include all of the psychologists, some of whom work a full day per week in practices. The program is so popular that one of the pediatric groups encouraged MMG to hire a child psychologist who spends a half-day a week in the practice. "There is a real interest in this program," says Scott.

Along with providing 30-minute consultations for patients, the program has an added benefit: Psychologists and the clinical social worker are available to physicians for consultation on problems their patients may have. And even though the time they spend at each practice is limited, Scott says the psychologists always are available for emergencies, and they will work outside their normal time frame in such cases. "We really can’t meet all the demand right now," she says. "That means the program will have to grow."

The behavioral specialists still carry their own caseloads, and the consultations are billed through the behavioral health department office, not through the primary care provider. "That makes us financially accountable, which is another thing the physicians like," says Scott.

Aside from letting the practice physicians know their schedule, there is little marketing done for the program. "We put signs in the lobbies saying that doctor so-and-so will be here Thursday afternoon and that they can see the receptionist to schedule an appointment," says Scott.

Not having aggressive marketing makes sense, she says, especially because most patients are reluctant to let others know they are seeing someone for a mental or behavioral health problem. By having this low-key approach, the stigma of seeking care is reduced.

That won’t work for every practice, Scott admits. "You have to have the demand there for it to work. And you have to look at your payer mix and make sure that this is financially a good idea. We often see patients without insurance or whose insurance won’t cover this and end up seeing them for free. But it is good for your patients."

You also need space to house a counselor or psychologist a half day or full day every week, she adds.

If you think there is some demand but not a lot, Scott says you can start out slowly. One of her psychologists began with a monthly stint for a half day and now has a full day once a week at the practice.

The situation also may be more complex for practices that don’t have affiliated behavioral health specialists, she says. But most practices do have a psychologist or counselor to whom they refer patients, and those doctors are the place to start. "Approach them and see if there is an interest."

"This is a great chance to do something good for your patients and also provide consultation opportunities for your physicians," Scott says. "If you have a patient, and something is not right, you can bounce things off of the psychologist. There is an opportunity for coordination of care."

Scott also points to the increasing number of studies that show that the cost of medical care goes down if behavioral health care needs are met. That means such a program can be a selling point to your payers. "This can keep people like substance abusers or potential suicides out of the emergency room and out of the hospital," she says.

Pediatric practices in particular might benefit from such a program, Scott adds. "The parents are either quick to want an attention deficit diagnosis or quick to discount such a diagnosis from a physician. This is a great help for physicians in those cases."


Nicola Scott, RN, MHA, Director, Behavioral Health Network Services, Methodist Medical Group, Indian apolis. Telephone: (317) 865-6922.