Pilot program to expand behavioral-health care

REMOVING STIGMA: Margaret Bublitz, right, a behavioral-medicine psychologist at Providence-based Women's Medicine Collaborative, speaks with nurse practitioner Kathy Ribeiro. / PBN PHOTO/ MICHAEL SALERNO
REMOVING STIGMA: Margaret Bublitz, right, a behavioral-medicine psychologist at Providence-based Women's Medicine Collaborative, speaks with nurse practitioner Kathy Ribeiro. / PBN PHOTO/ MICHAEL SALERNO

As a nurse, Debra Hurwitz has watched patients and family members attempt to navigate the mental health system, only to find it proves an almost futile exercise.

A Care Transformation Collaborative of Rhode Island pilot program, which integrates mental health clinicians into primary care practices, may help mild to moderate behavioral-health patients connect with treatment sooner, in a more cost-friendly manner.

“The catalyst was hearing over and over from providers how they made a referral to a behavioral-health specialist and never heard back. It was like a black hole people would fall into,” said Hurwitz.

Designed by CTC co-directors Hurwitz and Dr. Pano Yeracaris, the two-year pilot program will expand the range of treatments available at Rhode Island primary care practices across the state to include mild to moderate behavioral-health issues. The program will allow the primary care practices to hire clinicians or expand services already offered.

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By November, the pilot program will be launched in an estimated dozen CTC primary care practices, which operate as patient-centered medical homes and cater directly to the needs of patients through team-based, preventive care. The pilot results will help CTC determine if similar efforts should be expanded statewide.

Screenings would be performed by a medical professional and administered to every patient. If behavioral-health treatment is suggested, patients can meet with a clinician that same day or within a short period of time.

Two years ago, Hurwitz and Yeracaris put together a committee to address treatment barriers.

Building on the committee’s success, they presented a business proposal to the CTC board of directors and received $600,000 from the Rhode Island Foundation and additional funds from Tufts Health Plan before the pilot was launched.

“There really isn’t very good access [to treatment] for people in Rhode Island with mild or moderate behavioral-health issues. If you have severe mental health problems, like bipolar or schizophrenia, the community mental health centers are geared up for that. But, if you’re part of the mainstream there really isn’t good access and that’s where primary care comes in,” said Hurwitz.

Integration of mental health clinicians, as permanent fixtures in primary care practices, is a fundamental step in breaking down these barriers.

As a women’s behavioral medicine psychologist at Providence-based Women’s Medicine Collaborative, Margaret Bublitz knows the pain mental health patients experience when seeking treatment.

“Mental health carries with it stigma and one of the barriers to receiving care in the community is that patients feel stigmatized” accessing treatment at a specialist’s office, said Bublitz.

Bublitz thinks the primary care doctor is akin to a care manager.

“A patient may need to see specialists for physical problems and those results are communicated back to the doctor. We’re trying to do the same with mental health and have it be a more coordinated treatment plan,” she said.

By integrating behavioral-health clinicians into primary care practices, CTC’s pilot program provides an opportunity for patients to bypass stigmatization.

“Sitting in a primary care waiting room to see a behavioral health clinician, no one can necessarily know if they’re there to see a primary care doctor versus a clinician,” said Bublitz.

The program has helped small practices, like Women’s Medicine Collaborative, connect patients with the treatment they seek in a much faster, streamlined manner. According to Bublitz, the current need for mental health treatment has overwhelmed the capabilities of licensed specialists. It can often take as long as two months for a referred patient to see a mental health specialist.

“Some practices [before joining the pilot program] offered one session per week with a clinician, or a couple sessions per week. Some didn’t have an on-site, integrated therapist,” explained Yeracaris. “[The pilot program] pushed for universal screening of depression, anxiety and substance abuse and provided, minimally, an on-site, integrated clinician three days per week who can be available to interact with patients.”

Helping patients manage insurance copays and, on the provider side, limit uncompensated-care costs will be part of the challenge for the program.

“Part of the program’s hypothesis is that there will be fewer hospital visits and decreased in-patient hospitalization,” explained Yeracaris. “This will provide an impetus to fund these models going forward.” •

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