What is integrated care?

Integrated care is a form of care for patients with complex medical and behavioral health concerns by including the patient as a member of a team that can deliver both medical and behavioral services.

What is the IBH-PC (Integrating Behavioral Health and Primary Care)?

The Integrating Behavioral Health and Primary Care, or IBH-PC, initiative is the implementation of effective integrated care for your practice guided by toolkits, various resources, and an online community forum.

What are the goals of IBH-PC?

The goals of IBH-PC initiative are to:

• • • Improve the health of patients who have complex conditions, such as one or more co-existing medical and behavioral problems, by making it easier to access behavioral health services in the practice.

    • Integrate behavioral health provider(s) into the flow of practice operations so that medical and behavioral providers can work together.

    • Include other members of the practice as an inter-professional team to care for complex patients

Where do I start with implementing IBH-PC for my practice?

This IBH-PC website is your entry point. This site will give you access to the Start Up Guide, which will help you access the education modules and REDCap survey tools. It will also help you access the Leadership Guide and the 3-Stage Workbooks to guide you through the rest of the initiative.

What are the steps of IBH-PC?

Because IBH-PC is a long-term initiative, the work is divided into four separate steps. Each step is accompanied by a workbook or guide to help you through the process.

• • • Start-Up Guide (2-4 weeks) - The IBH-PC leader, or “champion” introduces the practice to the initiative, identifies members of the practice to participate in the Planning Group, evaluates the practice’s resources necessary to meet IBH-PC goals.

    • Stage 1 — Plan (3 months) - The Planning Group defines the scope of change based on the practice’s vision of IBH-PC, self-assessments, and decisions about next steps.

    • Stage 2 — Design (3 months) - The Design Group identifies how the practice’s operations will change based on the plan from Stage 1.

    • Stage 3 — Implement (3 months) - Test out changes in small, rapid cycles and refine them according to the design in Stage 2.

What is the timeline for IBH-PC?

The total timeline for IBH-PC will take 6-9 months depending on the size of the practice and patient population, available resources, and the practice’s engagement with the initiative. The Start-Up Guide will take 2-4 weeks to complete and each stage will take approximately 3 months to complete.

What is the purpose of a leader or “champion” for the IBH-PC initiative?

IBH-PC is a considerable objective that may require procedural changes, staff training and education, and planning and design according to your practice’s particular circumstances and goals. The leader, or “champion” will spearhead the initiative and lead in the planning, design, and support throughout the project. For more information on responsibilities of the “champion,” please reference the Leadership Guide, or reach out to your coach for more information.

What is the role of the Planning Group for the IBH-PC initiative?

The Planning Group will guide the practice through Stage 1 and will support the Design Team through Stages 2 and 3. The Planning Group will utilize the Stage 1 — Plan Workbook to define IBH-PC and scope of work for the practice, and will devise and organize strategies on how to best implement the initiative.

What is the role of the Design Team for the IBH-PC Initiative?

The Design Team will put the Planning Team’s strategies for IBH-PC implementation into action with guidance from the Stage 2 — Design and Stage 3 — Implement Workbooks. The Design Team will host regular working sessions to identify best tactics for the practice, gather continuous feedback from practice staff on improvements to the initiative, and fine-tune implementation setbacks.

What staff are needed for IBH-PC?

In order to implement IBH-PC to the best of your practice’s ability, the following staff members are required to support the initiative:

• • • Behavioral Health Providers

    • Primary Care Providers

    • Practice Manager/ Supervisor

    • Patient Partners

    • Senior clinical and administrative staff

    • Information Technology staff

    • Finance staff

    • Human Resources and Compliance staff

    • Retired providers/ staff

What are the education modules?

The education modules are a set of 30-45 minute interactive training videos organized by role. These modules define IBH-PC and how it impacts the experience of each role within the practice. Each member of the practice should complete their respective role’s education module over the course of 3 months.

Why is it necessary for my practice staff to complete the assigned modules?

The assigned modules provide staff with a clear and aligned approach to IBH-PC and a congregate understanding of the purpose, goals, timeline, and role-specific responsibilities.

For more information around staff engagement or further questions regarding the education modules, please post a question in the forum at the bottom of the page.

What is the purpose of patient partners?

Including a patient perspective early in the IBH-PC initiative can assist with identifying hindrances and noting areas for improvement throughout the implementation process. Patient partners can provide another point of view that can recognize how to better tailor the IBH-PC process to the practice and its patients.

For more information on how to engage patient partners, please reference the Partnering with Patients- Start Up Guide.

What if none of the patients available to me are interested in the program?

Consider reaching out to members of your community, with guidance from Module 3: Networking in the Medical Neighborhood.

Why are some patients resistant to scheduling a behavioral health appointment?

Behavioral health therapy may be initially frightening and confusing for some. There are a number of reasons a patient might refuse treatment, including uncertainty in the effectiveness of therapy, stigma around mental health, financial misconceptions, influence from family and peers, and/or previously failed attempt(s) at therapy.

What are some resources to help patients who are resistant to behavioral health services?

It is incredibly important to continue having your primary care providers reminding patients that behavioral health providers are available to talk. Below are some options for easing your patients into utilizing behavioral health services:

• • • Provide behavioral health telephone sessions. These may counteract concerns of time constraint or travel restrictions. Try approaching the phone call as a “discussion” rather than appointment scheduling.

    • Proactively de-myth stigma around mental health by emphasizing the potential positive outcomes of treatment or re-framing the appointment as a behavioral health “consultation.” See the question below for more guidance on minimizing mental health stigma.

    • Create a group session for patients with similar circumstances

    • Practice a warm hand off. If the behavioral health provider is occupied at the time of the warm hand off, bring the patient to required laboratory work or other necessary ancillary services until the behavioral health provider is free.

How do I minimize stigma surrounding mental health for my patients?

Your practice’s physical space is a great resource for exposing patients to behavioral health services offered. Consider adding flyers in the examination rooms describing the behavioral health services, and the BHP’s background and photograph. Adding a sensitive short description of the care team can personalize staff and alleviate patient hesitation. Utilize your practice’s primary care provider, front staff, and administrative teams to assure patients of a positive BH experience.

How do I reduce “no show” rates amongst patients?

No-show rates can greatly affect the capacity and productivity of the work-place. Consider producing an ongoing run chart of no-show data (events per day, or per week) as a management feedback tool to be reviewed monthly or quarterly. This tool can distinguish chronic no-shows from one-off appointment misses amongst patients. Analyze the reasons for no-shows amongst patients, and examine how your practice is influencing any barriers to appointments.

How do I engage my patients in shared decision making?

Module 4: Fostering Patient Activation Through Shared Decision Making can inform practice staff on why patient engagement falters and how to enhance it. Additional role specific patient activation modules can be found under the role’s designated education module site page.

What are the financial implications of IBH-PC?

The integration of behavioral health and primary care may have a different cost impact depending on the practice. Currently, we do not have explicit information on the financial implications of IBH-PC.

What are some of the CPT codes I can use for collaborative care/ behavioral health consulting?

The Medicare Codes for Collaborative Care and Behavioral Health Integration provides a step by step guide for billing for integration of care services. You can also use the following codes for encounters with licensed mental health providers:

• • • 90832 [16 to 37 minutes] = 30 minute visit

    • 90834 [38 to 52 minutes] = 45 minute visit

    • 90837 [53 to 60 minutes] = 60 minute visit

    • 90846 – Family therapy w/o patient present, needs to be at least 25 minutes

    • 90791 can only be billed once per 12 months (intake/initial)

    • 96150-55 (one unit per 15mins) [H&B Codes may be used when addressing a Primary Medical Diagnosis]

Please communicate effectively within your practice regarding any shifts in coding guidelines or routines, and refer to your internal financial specialist to ensure you are using the correct billing codes.

How can I improve the organizational flow of billing and coding changes?

Consider adding a process or “script” for patients around co-pays, including those for behavioral health, and create organizational policies that guide the practice through the patient’s transition to receiving integrated care. Identify which members of the practice will be designated to discuss financial information with the patient. Consult your internal human resources department to confirm your practice is compliant with any applicable regulations.

How do I bill for multiple providers, including social work?

Some commercial plans and Medicare may pay for the social work visit if a shorter psychotherapy CPT code is used, such as 90832. However, some plans may not cover an HBAI and a psychotherapy code for the same day. The Medicare Codes for Collaborative Care and Behavioral Health Integration are a monthly case rate, and can be a viable option for billing for multiple providers.

Is the inclusion of Care Teams cost-effective?

Evidence based collaborative care can be incredibly beneficial, as it enables the behavioral health providers to work with the psychiatrist as a BH team. The psychiatrist is able to conduct the initial evaluation and follow up, leading to the identification of organic mental conditions, appropriate medications, and third and fourth line interventions if improvement is not shown.

Please see the Index of Modules for guidance on appropriate care team education modules to expand on the importance of collaborative care teams.

How do I keep my staff motivated to take on IBH-PC?

In order to keep your practice engaged with the IBH-PC, you can utilize a set of tools identified below:

• • • Host frequent team huddles to discuss the current state of implementation, questions or setbacks that may have arisen, and actionable next steps

    • Praise personal and group achievements and acknowledge goals accomplished throughout the process

    • Re-frame implementation setbacks as opportunities for improvement

For more assistance with staff involvement, contact your office’s HR team.

Are there any federal/state regulations to consider prior to engaging in the IBH-PC initiative?

Please contact your Compliance staff for more information on licensure requirements and regulations surrounding IBH-PC.

How do I navigate the IBH-PC Site?

The bar at the top of the screen on the site window provides the options of "Home" , "Welcome to IBH-PC", "Education Modules", "Workbooks", "Coaches", "Library of Resources" and "Learning Community FAQ" which will navigate you to each respective page on the IBH-PC site. For those just beginning IBH-PC, click on “Home” to access the Welcome Package, and further links separated out by resource type, role application, and IBH-PC Stage. You can also click on the other header options, or hold your cursor over the drop down arrow for more specific links.

Where can I find links for resources separated out by Stages?

Scroll down to the bottom of the home page to find resources organized by stage. Click on one of the “Stage _” links and scroll to the bottom of the Stage _ page for links to stage-specific resources.

Where can I find role specific information?

The hyperlinks below will take you to role-specific education modules. If you need more information regarding your role-specific responsibilities, please contact your practice leader.

• • • Behavioral Health Providers (MSW, MA, PhD etc.)

    • Care Managers

    • Facilitator

    • Nurses

    • Physicians, Nurse Practitioners, PAs

    • Practice Managers or Supervisors

    • Staff

My practice often encounters special populations, where do I find more information on resources?

For more resources on special populations, click on Care Managers after holding your mouse cursor over the “Education Modules” drop down arrow. Scroll down the page you reach “Special Populations.”

Do I need specific online programs to access IBH-PC?

All workbooks and toolkits are either in Microsoft Word or PDF format. Some resources may open in a new browser, and require pop-up-blockers to be turned off.

Which internet browser do I need to access the IBH-PC site and resources?

Be sure you have Google Chrome, Safari, Firefox, Microsoft Edge, or Microsoft Internet Explorer browsers updated to the most recent version.

You can conduct a technology check here.

Where can I find the privacy and accessibility policies for each platform?

Click here to access links to specific platform policies.

Where can I find a glossary of helpful terms and acronyms?

A glossary of terms can be found in the Patient Partner Guide as well as a stand alone glossary under the Library of Resources page. You can review vocabulary related to integrated primary care in the Education Module 2: Integrated Primary Care Vocabulary.

Are there ways for me to modify EPIC work-flow to improve integration tactics?

There are several pathways for patients to complete a behavioral health screening online prior to their wellness exam.

• If your patient is part of the patient portal, send them an email to fill out a BH screen before their appointment

• A positive pre-screen can generate a full screen

• A positive answer about suicide prompts can prompt your practice’s nurse to conduct a phone assessment

• The PCP is alerted of the patient’s score which can be reviewed prior to the visit

• The clinical care assistant who rooms the patient can review the data and add paper tools if they are missing

Quick-Links:

Welcome Package

Start-Up Guide

Leadership Guide

Stage 1 — Plan Guide

Stage 2 — Design + Stage 3 — Implement Guide

How to Sustain the Results

Education Modules

Patient Partner Guide

Library of Resources

Who do I contact for more information about IBH-PC?

IBH-PC General Email: IBHPC-UVERMONT@med.uvm.edu

I have a question not on the FAQ list- where do I ask it?

You can go to the bottom of this page to ask your question in the provided forum.