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An Update from the Integrated Primary Care (IPC) SIG

Members of the Integrated Primary Care (IPC) Special Interest Group (SIG) had a productive meeting in San Diego in March 2008. Here are a few highlights of activities of some of its members:

Literature reviews of IPC are needed
Several members have joined forces to publish reviews of the IPC literature. These reviews can help clarify common language, focus the goals of those practicing integrated primary care, and identify the challenges facing the continued expansion of IPC.

Increasing reimbursement for Health & Behavior codes
At the annual meeting in San Diego, an energetic discussion was held that focused on the difficulties experienced by some SBM members in getting reimbursed by insurers for Health & Behavior (H&B) codes. While some members of the Integrated Primary Care SIG reported inconsistent reimbursement across insurers, other members reported little if any success in receiving reimbursement for services billed under these codes. Clinicians in SBM are likely to be among the best trained to deliver services described in the H&B codes, and such service is likely to be delivered in integrated primary care settings. Several SIG members bemoaned the need to bill for services as psychotherapy with the requirement to diagnose patients with mental health diagnoses in order to get reimbursed. In response to these difficulties, IPC SIG members Drs. Flora Hoodin, Abbie Beacham, Bill Sieber, and Jeff Goodie have taken action with the help of Mr. Prabhu Ponkshe, chair of SBM's Health Policy Committee and a policy analyst, to draft a policy statement encouraging insurers and legislative leaders to make reimbursement of Health & Behavior codes more standard. Members of the SIG also have voiced concern about how the H&B codes work for "non-psychologist" clinicians, as clinical social workers and others were included in the original language for reimbursement yet qualifications for these codes may have become unclear over time.

A recent release of a report funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), and Centers for Medicare & Medicaid Services (CMS) helps to support the expansion of IPC. However, it does not address the unique needs of those who practice behavioral medicine in getting reimbursed for brief interventions targeted at medical conditions such as insomnia, pain, and adherence. The American Psychological Association (APA) informed us that reimbursement of H&B codes depends less on private carriers and more on whether or not an employer has included coverage for health and behavior series in the contract that they sign with the insurer. Because of the wide variation in policies, and the thousands of existing private insurance carriers, APA indicated they do not have the resources to closely monitor this. APA has been receiving fewer requests to assist psychologists in convincing private insurers to cover these services and regard this decrease as an indication that carriers are now more willing to make health and behavior care a covered benefit. Dr. Roger Kessler, an IPC SIG member, recently published an article on this issue in Family, Systems, and Health, Vol. 26, #2. IPC SIG members have submitted a symposium on this issue for consideration at the 2009 Annual meeting in Montreal.

Primary Care Behavioral Health in the Air Force
Under the leadership of Lt. Col Neal-Walden, PhD, Chief of Population Health (Air Force Medical Operations), thirty four Air Force bases are now receiving core competency training in a model of integrating behavioral health services in primary care. Bases in Germany, England, Japan, South Korea, Alaska and numerous sites in the continental US have received a minimum of one week on-site training. About one-third of these bases are receiving additional on-site training in an effort to prepare a group of Behavioral Health Consultant (BHC) mentors who are ready to train other mental health providers for work in the Behavioral Health Optimization Program or "BHOP" (the program name for integrated care services in the Air Force). Publications supporting training efforts include Gatchel and Oordt (2005) and Robinson and Reiter (2007). Mountainview Consulting Group is providing the training, and trainers include Kirk Strosahl, PhD, Patricia Robinson, PhD, and Jeff Reiter, PhD, ABPP.

Compendium of IPC Training Sites
Flora Hoodin, PhD and Kevin Alschuler, M.S. of Eastern Michigan University, along with Abbie Beacham, PhD and Melanie Bierenbaum, M.S. of Spalding University have been busy compiling detailed information about graduate schools and internships/residencies that will serve as a resource to students, faculty, and professionals with an interest in Integrated Primary Care. The project's first phase in 2006 and early 2007 resulted in 27 participating sites recruited from the SBM IPC Special Interest Group and the Collaborative Family Healthcare Association membership. The second and current phase involves expanding the survey to clarify the specific nature of the collaborative/integrated care model as it operates at each training site, and expanding the reach to include additional training sites who listed a major or minor rotation in IPC on the Association of Psychology Postdoctoral and Internship Centers (APPIC) website. Data analysis of the 51 participating sites is in progress. Plans are to disseminate a searchable spreadsheet to IPC SIG members, Collaborative Family Healthcare Association (CFHA) members, and others upon request.

Planning for the 2009 Annual Meeting
Dr. Jeff Goodie (IPC SIG chair), in addition to seeking time at next year's annual conference for round table discussions, a lunch meeting, and a pre-conference workshop, hopes to obtain funds to support a student research award at the conference that would partially subsidize travel expenses for a graduate student or two.