How WellSpan Health’s integrated behavioral health and primary care model improves the patient experience.
The younger generation of medical professionals is considerably more engaged in addressing behavioral health concerns than those that came before, said Ken Rogers, MD, Vice President and Chief Medical Officer for WellSpan Health’s Behavioral Health Services. “This has caused a significant shift in the way healthcare is delivered,” he said. “There is now a greater understanding of this interface in primary care offices as well, compared to past generations.”
The integration of behavioral health within primary care is a current strategic focus for WellSpan Health. The health system has taken a highly personalized approach to care by fully considering each patient’s physical, emotional, social and spiritual well-being during primary care appointments.
“If physicians recognize that primary care is usually the first touchpoint for identifying a mental health concern, we can then incorporate behavioral health treatment when it’s necessary, and we’re doing that at WellSpan in a couple of different ways,” said Brian Pollak, MD, FACP, Doctor of Internal Medicine for WellSpan Health. “Currently, in primary care, we already screen for depression once a year.”
WellSpan Health’s integrated behavioral health model began as a pilot in 2014 with behavioral health trainees being included directly within the day-to-day workflow of the primary care practice. If a physician had a patient in the office experiencing a mental health concern, they could speak directly with an onsite behaviorist. This cohabitation lasted for a few years, but according to Dr. Pollak, eventually WellSpan chose to modify the model to create what exists today.
Screening as a starting point
In WellSpan’s current model, patients begin their primary care appointment by completing a Patient Health Questionnaire (PHQ) screening (a standard screening tool used by physicians to determine the severity of mental health concerns), along with other check-in questions, before their visit.
“A lot of mental health issues first appear in primary care, and primary care doctors are trained in and familiar with evaluating and managing anxiety and depression,” said Dr. Pollak. “Primary care physicians are often comfortable working with a certain group of medications, and then, if needed, we will typically ask for further support from behavioral health specialists, psychiatrists or counselors.”
If a patient does not complete a PHQ during check-in, then WellSpan’s clinical staff will ask the patient to complete the PHQ-2 during their appointment time and then will expand it to the PHQ-9, should the patient’s PHQ-2 scores be positive.
“Dr. Rogers and I have been involved in building out more of what we call ‘decision support’ for primary care – if a patient’s PHQ-9 score is positive, there is a prompt within the electronic health record (EHR) that says, ‘Hey, take a look, this person’s experiencing a moderate degree of depression,’” said Dr. Pollak. “This indicates to the clinical staff that they need to address the patients’ concern further. We’re trying to make this process much easier for the provider and also present them with a quick buffet of treatment options to develop more coordinated care.”
For patients requiring mental health treatment, finding an appropriate care plan can be notoriously difficult and confusing, with a behavioral health system that can often be a challenge to navigate.
WellSpan Health’s model aims to address these barriers for patients. Once an appointment with a primary care physician is complete, each patient is presented with a ‘SmartSet’ within the EHR, which groups all appointment follow-up information including medication orders, referrals and guidance on when further referrals would be appropriate – all in one user-friendly space.
Another way the health system simplified behavioral health treatment was by carefully evaluating provider referral processes. Primary care providers can now make direct referrals to behavioral health, expediting the patients’ process of receiving follow-up care and reducing wait times.
“The length of time between the referral being made and the appointment occurring can be lengthy – in most health systems, there is probably a month or so between somebody identifying a symptom and them getting into care,” said Dr. Rogers.
Instead, patient referrals now go directly into a queue within WellSpan’s EHR, where primary care staff facilitate referral processes to get patients in contact with behavioral health professionals,
and access to treatment options including support services like one-on-one therapy, peer support groups and medication sooner.
“Without someone to help you navigate what your real needs are, that can become very, very difficult,” said Dr. Rogers. “A large part of what we’re trying to do at WellSpan is to figure out how to really help folks navigate the complexity of behavioral healthcare and all of the treatment options that are out there.”
Key Takeaways
- Behavioral health is increasingly becoming a core component of primary care, with younger generations of physicians helping drive a shift toward recognizing and treating mental health concerns alongside physical health needs.
- Early screening and intervention are central to WellSpan Health’s integrated care model, using tools such as PHQ screenings and EHR-based decision support to help primary care providers identify and respond to behavioral health concerns sooner.
- Embedding behavioral health workflows into primary care can reduce barriers to treatment by streamlining referrals, improving care coordination and helping patients navigate a traditionally complex mental health system.
- Successful behavioral health integration requires more than adding services. It requires technology, provider collaboration and personalized care models that address patients’ emotional, social and overall well-being.