The Agency for Healthcare Research and Quality (AHRQ) www.ahrq.gov created the “Academy for Integrating Behavioral Health and Primary Care” https://integrationacademy.ahrq.gov as a response to the need for a national coordinating center to enable others to incorporate behavioral healthcare into primary care.
One of the communities working to embed behavioral healthcare providers in their primary care clinics as reported by AHRQ, is the Cherokee Health Systems www.cherokeehealth.com also a Community Mental Health Center (CHMC). This health system is located in East Tennessee is a Federally Qualified Health Center (FQHC). By emphasizing behavioral health integration, Cherokee strives to apply the Patient-Centered Medical Home model across all of their sites.
At Cherokee, Behavioral Health Consultants (BHC) work with primary care teams but also address behavioral health needs in the primary care setting. In addition to checking vital signs, nurses conduct patient screenings for depression, substance use, and other relevant behavioral health conditions using the screening tools embedded in the Cherokee electronic health system.
If the screening detects a problem, the primary care provider will inform the BHC and then the BHC will visit the patient. BHCs are increasingly being used to develop self-management goals and to further improve medication adherence. BHCs can also play a role in well-child exams where they use developmental milestone templates as guides.
In the event that a patient needs more specialty mental health care than is available through the primary care team’s BHCs, a patient will be transitioned to see a psychologist at Cherokee who works outside of the primary care team.
Since, Cherokee is both a CMHC and a FQHC, a specialty mental health is co-located in the same building as the primary care team to allow for frequent face-to-face communication between providers which limits the need for out-of-system referrals.
All of CHS uses the same EHR technology and Cherokee is anxious for the EHR to serve as a central repository for clinical information and be used to help with behavioral health, substance use, primary care, and medical specialties. Although Cherokee’s internal records are integrated, patient records are separated for out-of-system release.
Presently, Cherokee is piloting a patient portal where patients can request records, schedule appointments, and ask questions. Cherokee is also in the midst of preparing to launch an iPad pilot program. While waiting for a provider in the exam room, patients will be able to fill out screening forms on an iPad and then load the information directly into their EHR through a secure web browser.
The iPads may also serve to expand Cherokee’s telehealth efforts since psychiatrists could be called through the iPad during primary care visits, allowing the behavioral health provider to see and engage with the patient.