1. 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

2. 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.

3. Why Develop Jobs? Creates a feedback loop
Develops high fidelity training sites
Establishes your university as a leader
Makes team based care available

4. Why in Primary Care? Address professional shortages
Makes primary care more “fun”
Allows primary care to live up to its mission

5. 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

6. To Fully Integrate Your Specialty into Primary Care, Adapt It
Theory Burst #1
To Fully Integrate Your Specialty into Primary Care, Adapt It

7. Personal Example

9. Integration: An Evolving Relationship
Consultative Model
Co-located Model
Collaborative Model
Source:

11. 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

12. 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

13. 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

14. 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

15. 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

17. Fit Yourself (or a Friend) Into Primary Care
Group Activity
Fit Yourself (or a Friend) Into Primary Care

18. Developing a Business Model
Theory Burst #2
Developing a Business Model

19. 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

20. Business Model Comprised of three activities
Billable Services (Fee-for-Service)
Value-Added Services (Payer)
Value-Added Services (Patient/Provider)

21. Time Savings for BHC
Gouge, Polaha, Rogers, & Harden, 2016

22. Additional Revenue Gained

23. Business model starting places.
Group Activity #2
Business model starting places.

24. Discussion and Questions
Jodi Polaha, Ph.D.
Brian Cross, Pharm.D.