Integrating Behavioral Health in Primary Care Using Lean Workflow Analysis: A Case Study

∙ Full-time, on-site primary care behavioral health clinician (1 per 7,500 patients¹¹)

∙ Clinician availability for personal, face-to-face introductions (“warm handoffs”) and consultations

∙ Brief, evidence-supported treatment interventions; other clinical care responsibilities

∙ Intensive training of primary care behavioral health clinicians using standardized protocols for a broad range of psychological and medical problems amenable to behavioral health treatment

∙ Population (panel)–based care using measurement-based, stepped treatment and other resources

∙ Screening for mental health, substance abuse, and health behavior issues and provider decision support seamlessly integrated into patient flow

∙ Reengineering of practice processes, eg, “warm handoffs,” automated scheduling, referrals

∙ Training providers and staff in behavioral care procedures

∙ Appointment frequency and interval of behavioral health clinician consistent with primary care

∙ Shared, transparent EHR with 2-way notes and access to information

∙ Care management coordination of referrals and information with specialty care as needed

∙ Brief interventions, which are lower-cost services, provided over shorter episodes of care

∙ Coordination of services and finances to optimize sustainability

∙ Negotiation of appropriate reimbursement

∙ Regular reports of performance, RVUs, and financial data