Implementing Behavioral Health Care in Primary Care Practice

Virna Little, PsyD, LCSW-r, SAP, CCM, cofounder and chief operating officer, Concert Health, discusses how Concert Health’s platform supports primary care physicians in implementing behavioral health care in their practice, as well as how the collaborative care model advances value-based initiatives. 

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by Dr Virna Little, cofounder and chief operating officer of Concert Health. She discusses how Concert Health's platform supports primary care physicians in implementing behavioral health care in their practice, as well as how the collaborative care model advances value-based initiatives. Dr Little?

I'm Virna Little. I'm a psychologist, a social worker, and, I always say, administrator by trade. I'm the chief operating officer and cofounder for an organization called Concert Health, which is a behavioral health medical group that currently operates in about eight states but is expanding as we go.

Can you tell us a bit about your experience developing integrated care delivery systems over the course of your career?

Sure. I started my career working as a social worker in a large, federally qualified health center network in New York and received some grant funding for developing a program or services for seniors who were feeling sad and that we were working with at that time in the Bronx, New York.

At the same time, Project IMPACT was ending the research trial. The funder connected me with the folks in Seattle who had done the original IMPACT trial, which at the time was focusing on depression and seniors in primary care settings.

We essentially partnered. I worked to replicate that research project in the real world at what was called NORCs, naturally occurring retirement communities, in New York City, both in Manhattan and the Bronx.

I've been really working on building and implementing and integrating the collaborative care model pretty much since it started.

I spent my time working at the federally qualified health center there. We had, at the end, about 39 sites. I had about 300 behavioral health providers that practiced in primary care settings, doing collaborative care and doing integrated care.

I've also worked with the National Council for about 17 years now, working as a consultant on their integrated care team, and have had the pleasure of working with primary care associations and health care associations and organizations around the country, to really help build, what I like to say, clinically excellent and financially viable integrated delivery systems to expand access to behavioral health services and bring behavioral health services into primary care organizations.

Moving more into what Concert Health specifically does, how does Concert Health's system support the move toward value-based care?

Concert Health is a turnkey solution for providers and organizations bringing collaborative care, which is an evidence-based model to identify and treat patients with depression or anxiety in primary care settings.

One of the things we know about patients with depression in particular is that they are less likely to eat well for their diabetes. They're less likely to go to the cardiologist.

One of the things that we have been partnering with many of our organizations on is the ability to identify those patients with depression, look at some quality measures, look at their utilization.

Are they going to the specialty care? How are their hemoglobins ranking? How are they with their BMIs? Really partnering with them to identify populations of patients that we can help both physically and emotionally, to create the ability for the organizations to go into more value-based arrangements and for us, at some point, and them to essentially take some risk.

What would you say are some key challenges providers face when trying to implement behavioral health care in their daily practice? How does Concert Health's platform assist with those challenges?

Some of the things that I've learned in my career are all the reasons that this is hard for primary care providers. There are lots of reasons. Some, they think are harder than others.

I would say the first is that there's a lot of frustration with behavioral health over the years: patients not going, not getting feedback, not engaging in outside services, not being able to communicate with specialty mental health providers.

When we started Concert Health, we were very adamant that we were going to take those struggles out of the mix for primary care providers. We insist that we have to document in the electronic health record.

If an organization won't let us document in the electronic health record, we don't partner. No primary care provider ever has gone and entered into another system to look up something about their patient.

We also want to make sure they get a quick turnaround time. Our policy is same-day/next-day, but our response time is actually a couple of hours. That's super important to me, that somebody have access when they need it.

We also are clear to make sure that we're communicating back to the primary care provider. They know what's happening with their patients.

We're bringing the psychiatric consultants, so that they have support because we know that they write a majority of the medications for depression and anxiety anyhow. I would say, that's very specifically how we try to combat some of those.

Then, our ability to be almost plug-and-play, so that if there's our provider and an organization that would like to integrate services, then we provide those behavioral health professionals, the psychiatric consultants. We're familiar with a lot of the EMRs.

There's often no cost for them to add us to their electronic health records. They don't need to give up any space in their practice or worry about some of those pieces. It feels very doable for providers, where in the past it felt like something they would never be able to offer to their patients.

How do you think the pandemic's move to telehealth has impacted this whole process?

I would say, initially, what we found talking to patients was that they said, "We love talking to you over the phone. We love the choice of phone or video."

When we would talk to the primary care providers, they would almost always say, particularly when we started to work with them, "Nope. My patients want in-person. My patients will want in-person."

It was interesting to see the divide. What has happened is that the providers now say, "Oh, yeah. Actually, my patients are fine with phone and video. I've been doing it, and they're fine."

I've seen a shift in the primary care providers' feelings and thoughts about whether or not their patients would be receptive to behavioral health services by video or by phone.

That's been an important piece. I also think there was a lot of attention paid to educating providers, clinicians, on the behavioral health side about how to practice telephonically and by video. That was also helpful. On those two fronts, we saw some dramatic changes.

On your site, you separate women's health from primary care providers. I was wondering, how is the Concert Health platform uniquely beneficial for women's health?

One piece is that many women of childbearing age don't go to see their primary care provider. They often will only go see a GYN provider. A lot of those GYN providers do both women's health and primary care, but oftentimes, they feel a little less sure about some of the primary care, particularly the depression and anxiety.

We have psychiatric consultants and clinicians that specialize so that we can give them that extra support and understand that they may have a different framework than traditional primary care providers.

The other piece is that understanding the impact depression and anxiety have on moms and babies is important, and really bringing that into the care and treatment.

I would also say that particularly for OB providers, it's often scary for them when they get a woman referred to them and she's on medications for depression or anxiety or other mental health disorders.

Oftentimes, they're not sure what to do. Is this medicine safe for them to continue? Should I recommend changing a dose?

The last thing we want is for a woman who's pregnant to come off medications for a condition that would have a detrimental impact on her and the baby and maybe even threaten their lives.

The ability to have a psychiatric consultant that specializes in reproductive health to really guide that new mom or that mom and the OB provider is incredibly helpful.

Say, "You know what? No, it's fine. You're getting a little bit more anxious. This is how we're going to help care for you. It doesn't impact breastfeeding. This is fine for the baby," and really have those conversations, is incredibly important.

We consider it a specialty. We make sure that we really cater our services and our staffing to those providers.

Do you have anything else you would like to add today?

It's really important to start to encourage primary care providers in particular to think about their populations of patients. This is what collaborative care is meant to do, to put a systemic approach in.

They really have it down in terms of caring for their populations of diabetics. If you ask a primary care provider, they'll proudly tell you how many diabetics, what their A1Cs are, some of the things that they've put in place.

But they often don't think about their patients with depression or anxiety the same way, as a population. Many primary care providers still don't know that there are outcome measures for depression or anxiety or haven't put systems in place.

One of the things that we're hoping to do with our partners at Concert and for the world as a whole is to be able to encourage primary care providers to think in terms of populations and be able to care for that broad spectrum of people that they see and care for with depression and anxiety.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.