Upfront

When psychologists at St. Charles Health System in Bend, Ore., help a patient whose anxiety is masquerading as a stomachache, find ways to help a family manage a child's asthma or teach patients how to sleep better or lose weight, they're doing more than just improving patients' health and well-being. They're also having an impact on the health system's bottom line, with an initial study suggesting that such integration can lower annual health costs by nearly $900 per patient.

In 2009, St. Charles began integrating psychologists into three primary care clinics, four hospitals, a surgical center and a medical clinic that are part of the system, as well as two pediatric clinics with which the health system contracts. Exemplifying the mind-body connection, about a dozen psychologists now work side by side with physicians as behavioral health consultants who offer patients brief, targeted interventions.

"Before we did this, we noticed that when people would make a referral from primary care to specialty mental health care, people only followed through about 10 percent of the time," says psychologist Robin J. Henderson, PsyD, director of government strategies at St. Charles Health System. "Part of it had to do with stigma, part with access problems."

Placing psychologists just down the hall from physicians helps overcome those barriers, says Henderson, explaining that a physician can ask a psychologist to pop in as needed.

Take pediatrics, for example. "We found that the No. 1 reason people were coming in is not because their kids are sick," she says. "It's because of behavior problems." Pediatricians are too busy to teach parents parenting skills, she says, but a psychologist can make a big difference in just a few minutes.

"What I do as a ‘doctor extender' is allow the physician to move on and see more patients and practice at the top of his or her license as I practice at the top of mine," says St. Charles psychologist Sondra Marshall, PhD, who works as a behavioral health consultant at Central Oregon Pediatric Associates in Bend.

All the behavioral health consultants are psychologists, says Henderson, and the system plans to keep it that way. For one thing, she says, psychologists are the only ones who can bill using health and behavior codes. "But the primary reason we went this direction is because of the depth of training psychologists receive," she says, noting that the behavioral health consultants must tackle issues that go beyond mental health, helping people solve problems as diverse as diabetes, children's misbehavior, concussions, insomnia and side effects from medication.

The demand for behavioral health consultants from other clinics within St. Charles Health System is so high that Henderson has more job openings than she can fill.

Preliminary data reveal that the approach saves money.

In a study of about 400 patients in a family clinic, researchers examined how much patients cost in the year before and the year after an intervention by one of the health system's behavioral health consultants. On average, total medical costs dropped $860 per patient over the course of a year despite a small increase in pharmacy costs.

"It's not that they were getting more medication," explains Henderson. "It's that they were actually taking their medication."

A larger study of physical health and cost outcomes is now underway.

— Rebecca A. Clay