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Elhoms, CCS, CPC, consultant at Alpha Coding Experts LLC in Orlando, Fla. “The model that typically works best is the primary care physician employs an LCSW or team of LCSWs that internally handle the majority of behavioral health care and then contracts with a psychiatric consultant for services that require advanced expertise,” says Toni M. Revenue considerations Despite the benefits of behavioral health integration, experts agree that hiring a specialist requires a financial risk that isn’t easy for small independent practices to take. Even with these providers, Chandler says, there’s frequently a waiting list for patients requesting services.

integrated an adult psychiatrist, a pediatric psychiatrist, and five licensed clinical social workers (LCSWs)after physicians had difficulty finding providers who would accept Medicaid patients, says Debbie Chandler, MBA, CMPE, chief executive officer at the practice. Last year, Matthews-Vu Medical Group, a multi-specialty group in Colorado Springs, Colo.

Once they find a provider they trust, they tend to want to stay within the practice for as many services as possible, she adds. Trust plays a large role in whether patients ultimately decide to seek any kind of treatment and particularly behavioral health services for which there continues to be a stigma, says Bennett. In addition, Takoma Park is a culturally diverse city with many undocumented immigrants. As in many communities, there’s a growing need for these services because many providers don’t accept Medicaid, and there aren’t enough outpatient mental health centers to accommodate timely appointments.

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Earlier this year, A Plus Medical hired a certified registered nurse practitioner to focus on billable mental health services such as smoking cessation counseling and intensive behavioral therapy. Doing so makes sense because primary care physicians already have a rapport with patients, making it more likely that patients will follow through with behavioral health referrals, says Coley Bennett, CMM, CHA, practice manager at A Plus Medical, P.C., an independent primary care practice in Tacoma Park, Md. Creating a one-stop shop for addressing patients’ needs Experts agree that embedding a behavioral health specialist in the practice can potentially boost revenue and take pressure off physicians by serving as a resource for patients. If physicians don’t treat the depression, they likely won’t improve the diabetes, he adds. Depression fueling diabetes is one example. In some cases, a mental health problem is the root cause of the physical ailment, says Tien.

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Tien, MD, MHS, president and chief science officer at mdlogix, a software company that develops cloud-based solutions to help practices streamline behavioral health screening, care coordination, and outcomes reporting. “This isn’t just about someone’s mood-it’s about addressing physiologic problems that affect patients’ health,” says Allen Y. Aside from the revenue implications, incorporating behavioral health into a primary care practice also can help patients achieve better outcomes-both physical and mental. Behavioral health integration care management, another billable service that focuses on care coordination between a care manager and behavioral health specialist, pays approximately $49 for 20 minutes of services each calendar month. Providing behavioral health-related services can also help providers hit quality benchmarks, bill for new and/or higher-level services, and even address social determinants of health such as food insecurity, housing instability, and health literacy. For example, screening for depression, evaluating risk of opioid misuse, and screening for unhealthy alcohol use-all of which are billable-can help physicians increase reimbursement under the Merit-based Incentive Payment System. Yet talking about behavioral health is critical-particularly when physicians are increasingly held accountable for patient outcomes under value-based care models. “Severe depression and anxiety isn’t something you can address effectively during a 15-minute visit,” she adds.

Jortberg, Ph.D., RD, associate professor of the department of family medicine at the University of Colorado School of Medicine. They also don’t have the time, says Bonnie T. Physicians understand the connection between mental and physical health, yet many don’t feel equipped to address patients’ behavioral health problems.