Integrating Behavioral Health With PCMH PRIME

One in five children in the United States suffers from a diagnosable mental health disorder.

Here’s another stat: only 21% of affected children receive needed treatment for their mental health disorder.

There could be many reasons—affordability or perhaps parents or guardians do not recognize symptoms as a mental or behavioral illness. But the numbers indicate access to behavioral services may be the biggest roadblock to care.

That is not the case at Yogman Pediatric Associates in Cambridge, Massachusetts. Here, nearly 2000 pediatric patients can access mental and behavioral health services in their pediatricians’ office if they need it. Patients can receive their vaccinations, primary care, complete their sports physicals, and see a social worker—all in the same building.

Yogman Pediatric Associates is one of 79 practices across Massachusetts who earned PCMH PRIME Certification. PCMH PRIME is a voluntary certification program that recognizes primary care practices that demonstrate behavioral health integration capabilities. Developed by the Massachusetts Health Policy Commission, in collaboration with the National Committee for Quality Assurance (NCQA), PCMH PRIME certification promotes the delivery of comprehensive care that addresses the emotional, psychological and medical needs of patients in a coordinated way.

Yogman Pediatric Associates followed the medical home model for some time, but then decided to take things one step further. The practice hired a licensed social worker with experience in early childhood development. This social worker shared the same offices as the other providers and used the same electronic health record system to track patients.

Michael W Yogman, MD, assistant clinical professor of pediatrics at Harvard Medical School, said the results are impossible to ignore. Integrating behavioral health care benefitted providers, patients, parents, and their pockets.

“Providers were so positive about the impact this had on the office that they were willing to take salary cuts if need be, to continue having the social worker on staff,” Dr Yogman said. The social worker was initially funded by a grant.

“Our providers were so enamored with how beneficial it was for patients,” he said. “When there was a behavioral health crisis, they were able to walk across the hall and transfer the trusted relationship parents had with the pediatrician to a social worker who could see them on the spot and not have to wait six months to get an appointment with an unknown person.”

Dr Yogman estimates that providing a “warm hand off” probably saved the parents and children three or four sessions with an unknown therapist.

Dr Yogman wrote about the impact behavioral health integration had on his practice in Clinical Pediatrics. Twelve families from his practice completed a Parenting Stress Index survey before and after intervention with a social worker. The idea was to compare each parent’s stress level before and after they worked with the social worker. The average parent stress score decreased from the 44^th percentile to the 33^rd percentile.

Dr Yogman also found cost benefits to integrating behavioral health into his pediatric practice.

According to the report, the average monthly spending for patients continuously enrolled in the practice from 2013 to 2015 decreased by 50.28%. For patients designated in the comorbid Behavioral Health and Complex CSHCN registry, their average monthly spending of $1587.17 in 2013 decreased to $208.55 in 2015.

Dr. Yogman claims the medical home model prepared his team for making integration effective. He added that the coordination among them was beneficial for staff, patients, and their parents.

“We’ve gone through medical home certification already and it’s gotten us through a lot of work already in terms of electronic medical records, creating registries, then following up on referrals and doing some things in regards to care coordination,” Dr Yogman concluded.  “So, you know, the practice had to be ready for it, but it was a good thing.”

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