More Than Co-Location: Fully Integrated Behavioral Health and Primary Care in Houghton Lake

Since 2013, MidMichigan Community Health Services in Houghton Lake has been providing integrated behavioral health (BH) and primary care (PC). Since more than 70% of annual visits to their primary care providers have a behavioral health component, combining services made sense for this rural FQHC looking to make a greater impact in their community.

Integrated Primary Care is “the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.”1

At MidMichigan Community Health Services, this goes beyond being co-located in the same office space. Their team of 7 doctors operate the clinic with four distinct teams that work with separate sets of patients, with two behavioral healthcare providers who provide care to all patients as needed. Patient appointments are shared by BH and PC providers, and referrals are often instantaneous “warm hand-offs” with behavioral health providers being pulled in spontaneously or scheduled in when there is an anticipated need. They have found that when patients are referred for behavioral health services, even if it involves crossing a lobby to make a follow up appointment, the follow through is very low. This can be due to the stigma associated with behavioral health needs, transportation problems, or inconvenience. If patients can be seen immediately, within the same appointment or as part of the same care team, this problem is reduced. Common problems that indicate a need for a referral include HONDAS, patients who are:
• Hypertensive
• Obese
• Non-adherent to treatment plans
• Diabetic
• A1C elevated
• Smoking

The Integrated Primary Care Program at MidMichigan was developed by Stacey Gedeon, Psy.D., MSCP, after she completed a post graduate certificate in Primary Care Integration. This comprehensive training, along with her extensive background in health care psychology, gave her the tools she needed to start. Fully effecting change required management and physician support, workplace culture considerations, changes to the physical space (to centralize reception), and working with staff to recognize situations appropriate for a behavioral health consultation. Gedeon was awarded Clinician of the Year in 2014 by the Michigan Primary Care Association for her work to transform practice at her clinic and others.

In the Houghton Lake area, the health care challenges include poverty, lack of transportation, smoking, economic difficulties, lack of education, obesity, health care access, and lack of traditional mental health services. Integrated BH and PC works to make an efficient, practical solution for patients with chronic illness compounded with complex social needs.

The success with the program can be seen in its results. Integrated behavioral health and primary care decreases stigma, reduces costs, and impacts medication utilization. Patients now have open and immediate access to services, higher rates of follow through on referrals to services, and higher satisfaction rates. Providers now have close collaboration between BH and PC staff, with shared goals and comprehensive care delivery. As a Federally Qualified Health Center, MidMichigan is better able to serve their patients, particularly in their condition specific diabetes and pain management programs.

1http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf

Do you have a story to share about practice transformation? Contact Stacie Longwell Hill at [email protected]

Education to Practice is a service of the Michigan Health Council