H02 – Sustainable Clinician-focused, Patient-centered and Flexible Approach to PCBH Scheduling Within an Integrated Delivery System

Summary

Kaiser Permanente Northwest Region (KPNW) is a fully integrated delivery system located in Oregon and Southwest Washington. The organization has adopted the Primary Care Behavioral Health model (PCBH) within it 16 primary care clinics and currently employs 45 Behavioral Health Consultants (BHC) serving over 630,000 members. PCBH has evolved at KPNW over the past five years; creating greater opportunities for operational changes to support patient care and sustainability of the workforce. BHC are among the frontline staff carrying the burden, alongside medical clinicians and staff, of providing care for individuals and communities impacted by the pandemic. Unlike most presenting issues seen in primary care, BHCs are living with the losses, stressors and fears that effect their patients. In the ever-changing climate of the pandemic, there were continual changes to respond to. The accumulation of increased stress, patient demand and rapid changes contributed to higher volume of burnout and decreased moral. There was a strong need for leadership to support the BHC workforce particularly from an operational approach. The templates for BHCs scheduling were a reasonable place to start operational change. Not only was sustainable support needed for the frontline behavioral health staff, but there was an identified need to move more toward fidelity of the PCBH model. This shifted allowed for an increase “in the moment’ warm hand-offs, enhanced BHC flexibility for the various demands within primary care, and a facilitated an increase in BHC’s sense of control of their schedule. The previous template was frequently filled in advance, reducing opportunities for true warm hand-offs, less flexibility for patient needs and contributing to the BHC’s burnout experience. In a partnership between management and BHC staff, a new template and new workflows were created and piloted at two clinics. The new template developed what is called “BHC Directed” time. This new slot type designated 15-minute windows of time for BHC utilization. This flexible utilization includes warm hand-offs, care coordination/case management and supports the many additional tasks of BHC work. After several months of testing the model, the pilot rolled out to the rest of the region, allowing for increased communication with doctors and in-the moment warm hand-off both in-person and virtually. The template formula continues to be perfected but KP has demonstrated success in balancing the number of schedulable visits (same-day and future) and “BHC Directed” slots in order to align with the GATHER acronym and spirit of PCBH. We would also like to share how this template is utilized throughout the day by BHC and primary care staff, share examples of our template library, and the formulary used of same days visits to future schedulable appointments to maintain access, flexibility and meet productivity expectations.