5 minute read

My first job after postdoctoral training was at a family medicine residency program in central North Carolina. It was exactly what I wanted: a combination of direct patient care, graduate medical education, and program development.

I took over for Dan Marlowe, another medical family therapist who left to join the faculty at a brand new school of medicine up the road. In just a few years, Dan had established a new integrated behavioral healthcare (IBH) service at the family medicine center and hired another full-time behavioral healthcare provider.

There is a thin line between excitement and trepidation. I often felt both as I went to work each day building upon the tremendous foundation left behind by Dan.

Seeing patients was the familiar part; I already had 3,000 hours of clinical experience by this point. But I had zero hours of managing a clinical service line. Looking back, here are some recommendations for new clinicians learning the business of integrated care.

Become a Billing Manager Buddy

I recommend becoming buddies with the finance and billing managers. Be open about your experience and knowledge levels. Seek to understand their perspective and goals. Work together to create a sustainable billing model for your integrated care service. There is a good chance that they are new to behavioral healthcare coding and documentation practices.

You will need to learn how to use proper codes for IBH services (e.g., psychotherapy, health behavior interventions, substance use services). Staff will need training on documentation requirements and clinicians should use validated screening tools.

Leverage Collaborative Care Model billing, if applicable to your site. Explore Alternative Payment Models (e.g., VBP, bundled payments). Confirm that state Medicaid programs and commercial insurers reimburse for IBH and CoCM codes. Leverage telehealth codes for remote services.

I remember the first time my finance manager handed me a copy of their monthly billing and collections report. It was impossible for me to understand. Over time, though, that report helped me understand the perspective of the billing staff and the importance of the revenue cycle.

Harness Health Informatics

I also recommend working closely with the health information technology team to create all of the new documentation tools and reports you will need to continuously monitor and improve your clinical productivity. You may need to create new data tables and SQL queries that export and organize your productivity data. You may need to use data visualization software to show changes over time and quickly identify opportunities for growth.

As you track your productivity, praise your team and the clinic staff. Make announcements when you meet or exceed your productivity goals. Tell patient stories that illustrate how IBH services work.

Oddly enough, I used the GE Centricity electronic health record system during my doctoral training, predoctoral internship, and first job. Centricity has decent capabilities for productivity reporting. Many clinics, however, use systems with significant limitations. Work with your HIT team to make the most of your system.

Embrace the Curve

Embrace the learning curve, celebrate small victories, and don’t be afraid to ask for help. By learning the business side of integrated care and staying passionate about your work, you can shape the future of your IBH service.