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You now know why I have chosen the title “We are One!” for these four blogs. The answer of course is that CMHC’s who become Behavioral Health Consultants on integrated primary care teams will be One with those teams. There has a source of direction for us in the mental health field with the role out of the ICD-10 Codes and the DSM-5 come October 1, 2015. That is that these codes and diagnostic tools have prepared for us tools to use in integrated medicine:

Integrated Behavioral Medicine Specialty Focus in the DSM-5 and the ICD-10

To begin with let's define what Behavioral Medicine is so that we can be One with this definition: Behavioral Medicine is the interdisciplinary field concerned with the development and the integration of behavioral, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation.(Definition is provided by Society of Behavioral Medicine on their website at: http://www.sbm.org/about )

Specific DSM-5 and ICD-10-CM Codes and Categories related to the Integrated Behavioral Medicine Model

1. Schizophrenia & Psychotic Disorder Co-occurring  with Medical Condition
2. Bipolar Co-occurring with Medical Condition
3. Depressive Disorder Co-occurring with Medical Condition
4. Anxiety Disorder Co-occurring with Medical Condition
5. Obsessive-Compulsive Co-occurring with Medical Condition
6. Somatic Symptom & Related Disorders
7. Feeding & Eating Disorders
8. Elimination Disorders
9. Sleep-Wake Disorders
10. Sexual Dysfunctions

Rule of Thumb in Diagnosing Medically Related Co-occurring Mental Health Conditions

1. First: Put in the ICD-10-CM code for the Medical Condition which has brought on the mental health disorder
2. Second: Put in the mental health disorder code related to the Medical Condition
3. Third: the joint listing of both counts as a single diagnosis. This is important when dealing with patients which have co-occurring mental health disorders which are due to an medical condition like: 293.84 (F06.4) Anxiety Disorder Due to Another Medical Condition, because we as mental health professionals are not diagnosing the medical condition but rather the co-occurring mental health disorder related to the medical condition.

Focus and Desired Impact of an Integrated Behavioral Medicine Approach based on the DSM-5 and ICD-10-CM Codes is

This is a Life-span approach to health and health care for: Children; Teens; Adults and Seniors in racially and ethnically diverse communities. The desired Impact of this Integrated Behavioral Medicine approach coming from the DSM-5 and the ICD-10-CM Codes is: Changes in behavior and lifestyle can which: improve health; prevent illness and reduce symptoms of illness. The approach’s goal is behavioral changes which can help people: feel better physically and emotionally; improve their health status; increase their self-care skills and improve their ability to live with chronic illness. Finally using the coding such behavioral interventions can: Improve effectiveness of medical interventions; help reduce overutilization of the health care system and reduce the overall costs of care. Recognition is that the keysStrategies of an Integrated Behavioral Medicine approach using these codes is: lifestyle change; patient psychoeducational training and the provision of social support.

Now that we have looked at the impact of DSM-5 and ICD-10-CM has on the need for mental health professionals to become One with the integrated model now let us look at the two major Integrated Medical Models with whom CMHCs who become Behavioral Health Consultants will become associated with.

The Emergence of Patient Centered Medical Homes and Affordable Care Organizations 

The Affordable Care Act (ACA) has encouraged the transition in the medical health field to two types of medical organizations: Patient Centered Medical Homes (PCMH) and Affordable Care Organizations (ACO).

If Clinical Mental Health Counselors are to become successful in the emerging role of Behavioral Health Consultant (BHC) in PCMHs and ACOs, they will need to first need to know what are these groups before becoming One with them. You can read in detail “Affordable Care Act (ACA)-Implications for Clinical Mental Health Counselors” on my website at: http://www.coping.us/behavioralmedicine/affordablecareactimplications.html that  has links to a variety of sites which explain the ACA, PCMHs and ACOs in greater detail. But for our purposes here is a quick summary:

1. Patient Centered Medical Homes (PCMHs) 

Patient Centered Medical Homes (PCMH) objectives are:

1. Patient Centered – which empowers patients with information and understanding
2. Comprehensive - Co-location of care providers of physical and behavioral health in close proximity with one another
3. Coordinated Care - Through Health Information Technology all providers are kept in touch with common records on all clients accessible through their PCMH Electronic Health Records (EHR)
4. Accessible – same day appointment and 24/7 availability through technology online
5. Committed to Quality and Safety – Quality improvement goals which are tracked

Benefits of Patient Centered Medical Homes

1. Patients seek out the right care which is needed and it is often behavioral vs. physical
2. Less use of ER’s or delays in seeking care
3. Less duplication of tests, labs and procedures
4. Better control of chronic diseases and other illnesses improving health outcomes
5. Focus on wellness and prevention – reduce incidence and severity of chronic disease or illnesses
6. Cost savings less use of ER’s and Hospitals

What is moving the Patient Centered Home Health Model?

The Patient-Centered Primary Care Collaborative (https://www.pcpcc.org/) pointed out on its website these factors are driving the Patient Home Health Model:

1. Unsustainable cost increases in health care delivery
2. Growing availability of data
3. Vast changes in the way we communicate, thus the increase of telehealth

2. Affordable Care Organizations (ACOs)

Goal of an ACO

The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

What are ACO’s

1. ACO assumes financial risk rather than 3rd party payers (government, business or insurance companies) for group of patients assigned to it
2. Consists of more than one hospital and number of primary care clinics with full array of medical and health specialists-who self-refer to their own specialists
3. Control costs by being responsible for full care of patients
4. Integration of mental and behavioral health services into Patient-centered medical homes
5. Enhance patient outcomes through emphasis on prevention, compliance, and immediate 24/7 attention
6. Utilize an integrated behavioral medical approach

What is next for our AMHCA Integrated Medicine Community?

On our AMHCA Connections Site, we will begin to get more specific with knowledge and skills needed to be successful in the Integrate Primary Care settings. We will be constantly seeking our members input as to what issues and concerns they need covered and discussed. We will always be making our members aware of new webinar offerings from AMHCA and/or its state chapters on Integrated Medicine. We will be constantly monitoring AMHCA’s public policy initiatives especially those related to Integrated Medical Care, Insurance Reimbursement and of course my major passion medicare coverage for CMHCs.