Access Community Health Centers is a federally qualified health center that provides integrated behavioral health and primary care services. With three integrated care clinics in Madison, Wisconsin, the Agency for Healthcare Research and Quality (AHRQ) has identified Access Community Health Centers as a Service Delivery Innovation.
Access Community Health Centers began providing integrated care because of the realization that many patients referred to behavioral services in the community did not follow up on the referrals. The care clinics provide care to vulnerable populations, including patients who are impoverished, medically or socially complex, and mentally ill. A majority of patients receive Medicaid benefits, one-third of patients are minorities, and one-fifth of patients speak a language other than English.
To deliver integrated care, Access Community Health Centers has a behavioral health team consisting of five full-time psychologists, three full-time social workers, and a part-timer consulting psychiatrist. The psychiatrist spends 10 hours per week in the primary care clinics. Practicum students, medical residents in psychiatry, and postdoctoral fellows also work there. This staff is distributed among the three care centers. An initial assessment of behavioral health needs among the patient population led physicians to believe “they could handle many of the cases currently being referred if they had more support from psychologists or social workers.” In the beginning, only a part-time consulting psychologist was used. However, patients had more complex needs than expected which led the care team to introduce psychiatric services. The consulting psychiatrist sees patients for a one-time consultation rather than for repeat visits, which allows the psychiatrist to see more patients. All members of the care team have complete access to patient medical records. The behavioral health team, consulting psychiatrist, and primary care providers work together to provide care and monitor patient health. However, the primary care provider maintains decision-making authority.
Integrated care has resulted in increased access to behavioral health services, more engaged patients, more screening for depression, more documentation of behavioral goals, fewer referrals, and less medication use. AHRQ lists the evidence rating as moderate based on “pre- and post-implementation comparisons of various measures of primary care clinician involvement in behavioral health treatment” and “post-implementation trends in the number of primary care patients accessing behavioral health services in the primary care clinics.”