Role & Fiscal Sustainability of PMHNPs within Primary Care

1. Role & Fiscal Sustainability of PMHNPs within Primary Care Susan Marie, PMHNP PhD Medical Director for Behavioral Health Old Town Clinic, Central City Concern

2. Success = • Clear Roles & Processes • Preventing Cultural Pitfalls • Sustainable Revenue

3. Roles • Behaviorist • Who: various flavors- social workers, counselors, psychologists, unlicensed mh staff- check licensing/revenue • What • Crisis intervention/suicide intervention • Diffusing hostility • Brief cognitive-behavioral treatment anxiety • IMPACT problem solving intervention • Linking to resources • Teaching skills: relaxation, trauma management

4. Roles • Psychiatric Expertise • WHO • Psychiatric nurse practitioner or psychiatrist • WHAT • Just-in- time consultation to primary care providers • Focused psychiatric assessments • Psychiatric medication management “weave in & out” • Crisis/suicide support • PCP psychopharmacology support and training

5. Preventing Cultural Clash Specialty Mental Health Caseload of clients- “full” Values confidentiality Independence Never interrupt Integrated Primary Care Serve PCP panels Values collaboration Team Encourages interruptions

6. MENTAL HEALTH “Therapist” “Sacred 50 min hour” Full evaluation before treatment Episodic PRIMARY CARE Varied Roles Shorter appointments Develop assessment as you go Ongoing, as needed

7. Sustainable Revenue • OHP Health Plan (medical) • E&M Codes • Health & Behavior Codes • Mental Health Plan • “Mental Health” codes

8. E & M Codes • FCHP pays E & M codes • Operationally defined “primary care behavioral health” • Assessing, diagnosing, and treating mental illnesses What the primary care provider would be doing if psychiatric provider was not there • Provided in same physical and temporal space of primary care

9. E&M Codes: The Rationale • Less cost • Less stigma • Increased access • Better outcomes

10. E&M Advantages/Disadvantages • Similar charting requirements as PCP • Similar billing as PCP • No same day payment • No coverage of non-medical BH staff • Only brief interventions covered (99212, 99213)

11. OHP Mental Health Plan • Services to diagnose and treat mental illnesses • Expectations inconsistent with primary care model • Clinical record keeping • Clinical supervision & review • Quality improvement processes • Increased administrative burden • Credentialing/licensing • Auditing • Prior authorization procedures

12. Advantages/Disadvantages • Same day with PCP visit • Case management, counseling services • Wider variety of providers • Requires state license as behavioral health provider • Requires contracting with MHO • State expectations (eg CPMS) • Differing expectations by MHO

13. Now It’s Your Turn. Questions??