Evergreen Health, a Maryland-based consumer-operated and oriented plan known as a CO-OP funded by the federal government under the Affordable Care Act, has gone where few other health plans have dared to go. It is taking a collaborative or holistic approach that fully integrates behavioral health with primary care for more meaningful results.

Examples include the use of a health “coach” who screens each member for depression, anxiety and substance use, while primary care practitioners provide medication management of routine psychotropic medications. In addition, the CO-OP has responded to a nationwide shortage of psychiatrists through a tele-psychiatry service on Skype in 2015 aimed at reducing wait times for appointments and enabling providers to operate more efficiently.

Also see: Therapy goes digital

The motivation is simple – and pragmatic. “Half of primary care visits have at least some component of behavioral health to it, whether it’s anxiety leading to stomach aches, or sleeplessness because of depression, domestic violence, substance abuse, or whatever,” explains Peter Beilenson, M.D., founder, president and CEO of Evergreen Health, which is one of 23 CO-OPs operating in 24 states.

“Aside from us,” he adds, “I don’t think anyone else runs their own health care system. We’re not a full health care system; we don’t have hospitals. But we are a primary care, patient-centered medical home. We have four of them, which all follow the integrated health model. Most of the others have their own networks of providers, and they’re like other insurance companies – only they’re nonprofit and they’re governed by their members.”

Beilenson was a health commissioner in Baltimore for 13 years prior to running for Congress on a single-payer platform. He later became a suburban county health commissioner in Howard County, Md., where he established a local health access program for the uninsured.

He started Evergreen Health to align the interests of insurers and providers “so that the care centers are paid capitation, and in return, they provide truly robust patient-centered care, including behavioral health, mental health, substance abuse treatment, health coaching, as well as medical, physical, or somatic care.”

Health plan members are happy about all the time they’re getting with their doctors, who receive a salary instead of fees for service, according to Beilenson. While acknowledging the provider panel is on the smaller side, he notes that the level of service is much more personalized, and everything is addressed during a single stop.

Evergreen Health also has its eye on tele-medicine down the road in hopes of targeting referral-heavy specialties such as cardiology and dermatology. “We’re adding one every couple months,” Beilenson reports.

Also see: Telehealth technology curbs employee costs, improves efficiency

With tele-psychiatry, a licensed clinical social worker who doubles as an on-site health coach and substance abuse/mental health counselor conducts an initial evaluation to determine whether a psychiatrist needs to be seen. If medication is then prescribed, medication checks can be done “fairly easily via the tele-psych tool, which is really the best use of it in many ways,” he says. “By having everything all in one place, including your med check and a 10-minute quick check-in with a psychiatrist instead of having to drive 40 minutes to go see a psychiatrist somewhere else, the compliance is unquestionably going to be better.”

How unusual is this approach? “It’s very rare that in a conventional medical practice there is a specific person in your doctor’s office who is a licensed clinical social worker, as well as a nutrition and physical activity counselor, who could do mental health and substance abuse services,” Beilenson says. The exception is in large, multi-specialty practices.

Bruce Shutan is a Los Angeles-based freelance writer.

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