1. Role & Fiscal Sustainability of PMHNPs within Primary Care Susan Marie, PMHNP PhD Medical Director for Behavioral Health Old Town Clinic, Central City Concern

2. Success = Clear Roles & Processes Preventing Cultural Pitfalls Sustainable Revenue

3. Roles Behaviorist Who: various flavors- social workers, counselors, psychologists, unlicensed mh staff- check licensing/revenue What Crisis intervention/suicide intervention Diffusing hostility Brief cognitive-behavioral treatment anxiety IMPACT problem solving intervention Linking to resources Teaching skills: relaxation, trauma management

4. Roles Psychiatric Expertise WHO Psychiatric nurse practitioner or psychiatrist WHAT Just-in- time consultation to primary care providers Focused psychiatric assessments Psychiatric medication management “weave in & out” Crisis/suicide support PCP psychopharmacology support and training

5. Preventing Cultural Clash Specialty Mental Health Caseload of clients- “full” Values confidentiality Independence Never interrupt Integrated Primary Care Serve PCP panels Values collaboration Team Encourages interruptions

6. MENTAL HEALTH “Therapist” “Sacred 50 min hour” Full evaluation before treatment Episodic PRIMARY CARE Varied Roles Shorter appointments Develop assessment as you go Ongoing, as needed

7. Sustainable Revenue OHP Health Plan (medical) E&M Codes Health & Behavior Codes Mental Health Plan “Mental Health” codes

8. FCHP pays E & M codes Operationally defined “primary care behavioral health” Assessing, diagnosing, and treating mental illnesses What the primary care provider would be doing if psychiatric provider was not there Provided in same physical and temporal space of primary care E & M Codes

9. 1) Less cost 2) Less stigma 3) Increased access 4) Better outcomes E&M Codes: The Rationale

10. Similar charting requirements as PCP Similar billing as PCP No same day payment No coverage of non-medical BH staff Only brief interventions covered (99212, 99213) E&M Advantages/Disadvantages

11. Services to diagnose and treat mental illnesses Expectations inconsistent with primary care model Clinical record keeping Clinical supervision & review Quality improvement processes Increased administrative burden Credentialing/licensing Auditing Prior authorization procedures OHP Mental Health Plan

12. Same day with PCP visit Case management, counseling services Wider variety of providers Requires state license as behavioral health provider Requires contracting with MHO State expectations (eg CPMS) Differing expectations by MHO Advantages/Disadvantages

13. Now It’s Your Turn. Questions??