Teaming Up in Primary Care: Sustainable Models in the Real World Jodi Polaha, Ph.D. Quillen College of Medicine Brian Cross, Pharm.D. Gatton College of Pharmacy
Objectives To list rationale for developing permanent positions for students in local team-based primary care. To describe modifications to the practice of your discipline to “fit” into a fully integrated model in primary care. To develop key aspects to a business proposal to bring a new team member into a primary care clinic.
Why Develop Jobs? Creates a feedback loop Develops high fidelity training sites Establishes your university as a leader Makes team based care available
Why in Primary Care? Address professional shortages Makes primary care more “fun” Allows primary care to live up to its mission
Fitting into Primary Care What are the characteristics of this setting? Population Health Short, targeted appointments Protocolized approaches to common chronic illnesses Adaptation to policy changes and new science – QI skills Physicians practice as generalists
To Fully Integrate Your Specialty into Primary Care, Adapt It Theory Burst #1 To Fully Integrate Your Specialty into Primary Care, Adapt It
Personal Example
Integration: An Evolving Relationship Consultative Model Co-located Model Collaborative Model Source: http://uwaims.org
Why PCBH? Wide range of behavioral issues, ages in primary care Chronic disease management Somatic complaints with lifestyle/stress component Sub-threshold problems Preventive health All manner of psychiatric, substance abuse problems Infants through older adults
Why PCBH? Patients with psychosocial issues are higher utilizers Of 14 common symptoms in primary care, only 16% had organic etiology (Kroenke 1989) Anxiety, loneliness drive visits (Fries, 1993) Half of high-utilizers have a psych or CD problem (Friedman, 1995) Patients with psych disorder utilize 50% more physical health services (Simon et al, 1995) (Fries 1993 NEJM) anx, loneliness determine who is likely to come to Dr—others w/ same medical condition don’t come in
Why PCBH? Primary care providers can’t do it alone 10 or 15 mins per visit 3 complaints on average/visit Insufficient training in behavioral interventions Over 3 dozen urgent but unpaid tasks everyday Need 7.3 hrs/day to implement all USPSTF recommendations Need 10 hrs/day to implement chronic care recommendations 52,000 new PCPs needed to implement healthcare reform Overworked, underpaid—stressed! Overworked: NEJM study April, 2010, PCPs do over 3 dozen urgent but unpaid tasks qd New emphasis on patient-centered health care home
Primary Care Behavioral Health GOAL: Improve the efficiency, effectiveness of PC Consultant model Member of primary care team, work side-by-side Goal is to improve PCP mgmt of behavioral issues Wide variety of interventions and goals Brief visits, limited follow-up Immediate feedback to PCP Any behaviorally-based problem, any age Aim for immediate access, minimal barriers Rooted in population health principles
The Behavioral Health Consultant (BHC) Dimension Primary Care Behavioral Health Traditional Behavioral Health Primary consumer PCP Patient/Client Care context Team-based Autonomous Accessibility On-demand Scheduled Ownership of care Therapist Referral generation Results-based Independent of outcome Productivity High Low Care intensity Problem scope Wide Narrow/Specialized Termination of care Pt progressing toward goals Pt has met goals Collaborative Family Healthcare Association 12th Annual Conference
Fit Yourself (or a Friend) Into Primary Care Group Activity Fit Yourself (or a Friend) Into Primary Care
Developing a Business Model Theory Burst #2 Developing a Business Model
Business Model The Benefits of Seed Funding Time to onboard system wide Opportunity to experiment with billing mechanisms Opportunity to collect data demonstrating ROI both: 1) financial and 2) value-added/time-saving
Business Model Comprised of three activities Billable Services (Fee-for-Service) Value-Added Services (Payer) Value-Added Services (Patient/Provider)
Time Savings for BHC Gouge, Polaha, Rogers, & Harden, 2016
Additional Revenue Gained
Business model starting places. Group Activity #2 Business model starting places.
Discussion and Questions Jodi Polaha, Ph.D. polaha@etsu.edu Brian Cross, Pharm.D. crossl@etsu.edu