Integrated Care: Lessons Learned
One of APA Practice Organizations goals is to promote psychologists in integrated healthcare systems and help psychologists transition into integrated care positions from more traditional practices. The recent regional integrated care summits sponsored by the Practice Organization (including upcoming Midwest Forum in Chicago June 24: https://illinoispsychology.org/2016-Midwest-Summit) are a great example of APA Practice Organizations initiatives. Topics covered will include Alternative Practice Models; Working with Payers to Foster Better Care and Demonstrate the Value of Psychology; Risk Management and Legal Considerations in Integration: and How Psychologists and Physicians Can Communicate and Collaborate More Effectively.
As a psychologist who has practiced in integrated care for most of my 12 year career, and as I consider transitioning to a new integrated care area, I’ve been thinking about what makes it work and some of the challenges.
Integrated team. Psychologists may be referred within a healthcare system and located separately, co-located but functioning separately, or fully integrated into the team. My experience is the more fully the psychologist is integrated into the team, the better patient outcomes. This includes regular integration into meetings, face to face discussions regarding patients, and coordinated scheduling for patients.
Staff privileges. Being recognized as a doctoral provider on par with the rest of the medical staff is key. Some states/hospitals have rules about this; psychologists as doctorally trained professionals should be seen as colleagues rather than “ancillary staff.” This can mean better access to research/conference funds, better benefits, and more leadership opportunities.
Flexibility. Be available to the medical staff/team when needed. Being able to see patients on the fly in an exam room, by request the same day is important. Creativity when it comes to office space, group space may help you to function better in a hospital environment.
Outcomes measures. Psychologists have an advantage with their research training, and integrated care is a great place to use these skills. Showing how psychological treatment positively influences medical outcomes can make your work meaningful to the rest of the team and likely to be tied to economic advantage as healthcare reform continues.
Understanding the biopsychosocial model. Good understanding of the medical area you are working with is important, as well as the psychological and behavioral factors that affect the condition. Shadowing the team members, doing background reading and coursework, and attending key scientific meetings will help you to be more effective clinically and work with the team.
Take advantage of teaching opportunities. Psychologists who are part of resident education, in-services for staff, and continuing medical education have the opportunity to share their expertise, increase awareness of psychological factors affecting medical care, and improve understanding of how they can serve patients.
Cultural competence. Psychologists bring a strong understanding of the strengths and the unique needs of diverse populations that is an asset in the integrated care setting.
Interpersonal skills. As a member of a team, it is important to value every discipline and piece of the system. Learning to navigate the intricacies of hospital politics is essential to success.
Stay current. Whether presenting research, attending national conferences, or keeping up with journals in your field, psychologists in integrated care must be aware of current trends and be able to apply new knowledge to clinical care.
Know your reimbursement. Psychologists are often the odd ducks in a medical model. They need to understand how their salaries are determined and how their services are reimbursed. They should be familiar with and tracking metrics like CPT codes, RVUs, amount billed, amount collected, PQRS, and trends in value based reimbursement. It’s not the only thing their worth is measured by, but it can be a problem if ignored.
Check out these links to resources and professional guidelines for integrated care:
Practice Guidelines www.apa.org/practice/guidelines/index.aspx
Guidelines for Psychological Practice in Health Care Delivery Systems http://www.apa.org/practice/guidelines/delivery-systems.aspx
APA Center for Psychology and Health http://www.apa.org/health/index.aspx
