health specialists or hiring specialists to assist them in their practices .”
CPC + AND ASSOCIATED TRAINING
Working with The REACH Institute , Dr . Gibson organized training in 2017 for 48 Baptist PCPs . “ Several Arkansas physicians attended and later called on me for psychiatric collaboration on some of their patients ,” she said . “ We were participating at the time in a Centers for Medicare and Medicaid Services initiative called Comprehensive Primary Care Plus ( CPC +), a value-based care program where CMS and several commercial payors gave incentive funds to participating practices over a five-year period to adopt a team-based care model that included behavioral health specialists , dieticians , pharmacists , and care managers . Evidence shows that for people to get better in their overall health care , we needed to address their emotional and mental health issues .”
Larry Braden , MD , participated in the CPC + initiative before retiring from family practice at Ouachita Valley Family Clinic in Camden . He offered a compelling comparison of the practice “ beforeversus-during ” the initiative . “ For the first 30-35 years of my practice , we were pretty much on our own relative to mental health care for our patients ,” shared Dr . Braden . “ We ’ re in south Arkansas , and we had a government-funded counseling service in town , but no real psychiatrists involved . We did the best we could in the context of a model of care that gave us 10-20 minutes per patient . When we had an acute psychiatric need , it required a lot of time and was disruptive to an established appointment system .”
Enter Dr . Gibson and the CPC + initiative . “ At first , we were cautious – not resistant , but cautious . Before it was over , we were enthusiastic as a group . It was two years there of psychiatric bliss ,” recalled Dr . Braden . “ Dr . Gibson ’ s idea was to make sure we had a basic knowledge of psychiatry and she would always be available for psychiatric consultation – something we had never had . We had backup by telephone , and she would refer to a psychiatrist when needed .
“ The next step was the winner ,” he continued . “ We brought in master-level counselors , which enabled us to have soft referrals in clinic . If patients were manifesting some psychiatric need , I would offer them this new in-clinic service . We started with one counselor ; before long , we had two , all-day , in-clinic counselors seeing patients . They would come at our call , spend 10 minutes with the patient of our concern , plan follow up , and return to their counseling work . They took over referrals as needed and worked with me when there was a need for medication . It was much more efficient .”
Bill Dedman , MD , is still a practicing partner at Ouachita Valley Family Clinic and worked with Dr . Braden during the clinic ’ s CPC + initative . Currently staffed by three physicians and four physician extenders , the Camden clinic serves a patient population of about 6,000 .
A long-time family physician , he echoed his colleague ’ s enthusiasm towards CPC + and touched on the importance of treating mental health . “ I ’ ve done all kinds of family medicine including obstetrics ,” began Dr . Dedman . “ I deal with various emotional and behavioral issues in children and adults . Anxiety and stress are so common that we must deal with it … attention deficit , too . If I don ’ t do it , they may not get help for months . That ’ s why family doctors are so important when it comes to delivering that care , as are pediatricians and internal medicine physicians .”
Of the training he and his partners received through The REACH Institute , he continued , “ It was one of the best conferences I ’ ve been to in terms
of helping primary care physicians understand and have confidence in managing and treating behavioral health integration . The subsequent CPC + experience and the financial help it provided was an extraordinary program that we miss . For a period , there was no cost to the physicians or the patients .”
Between COVID and the CPC + funding ending , the clinic has been unable to get a counselor back in the clinic . “ We ’ re trying ,” said Dr . Dedman . “ I ’ m not sure it ’ s something we can do without financial support . Most physicians will say this is something that is so important to us – probably 20 or 30 % of patients that we see every day need this – but to get that financially reimbursed is a struggle .”
Meanwhile , it ’ s back to the old way at the Camden clinic : relying on local area counselors as needed . “ It ’ s slow to get in , and it ’ s not nearly as effective and efficient as having someone in house ,” said Dr . Dedman . “ Then , too , some counselors will take insurance , and some will not . The financial part of seeing a counselor can be a blockade for patients .”
STEPHANIE CODY , MD , is another family physician determined to maintain behavioral health assistance even after losing CPC + funds . She practices at Hillcrest Baptist Clinic in Little Rock and currently benefits from one in-house licensed social worker , Darren Reeves , LCSW .
“ Mental health has always been important to me , so when I had the opportunity to bring it into the clinic , I jumped at that ,”
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FALL 2022 | VOLUME 119 | NUMBER 2 39