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The American Journal of Accountable Care June 2018
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Jason Alexander, BS, PCMH CCE; Jordon Schagrin, MHCI, PCMH CCE; Scott Langdon, BA; Meghan Hufstader Gabriel, PhD; Kendall Cortelyou-Ward, PhD; Kourtney Nieves, PhD; Lauren Thawley, MSHSA; and Vincent Pereira, MHA, PCMH CCE
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Lessons Learned in Implementing Behavioral Screening and Intervention
Richard L. Brown, MD, MPH
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Lessons Learned in Implementing Behavioral Screening and Intervention

Richard L. Brown, MD, MPH
This article describes lessons learned over the past 10 years while helping several dozen primary care settings implement evidence-based, cost-saving behavioral screening and intervention.

Value-based reimbursement programs are creating strong incentives for primary care settings to deliver evidence-based behavioral screening and intervention (BSI). BSI for unhealthy drinking, depression, and smoking improves outcomes and generates substantial cost savings. Addressing other behavioral risks and disorders may also reduce costs. From experience helping dozens of primary care clinics implement BSI, the author makes several recommendations: expand the healthcare team, because BSI requires ample time; hire full-time bachelor’s-level health coaches selected for their personality attributes rather than prior training and experience; initially, deliver BSI for patients of one clinician, and optimize workflow, then serve patients of other clinicians; obtain buy-in from all clinicians and staff with strong support from healthcare organization and clinic leaders, data demonstrating patients’ need for BSI, initial success stories, and local data documenting effectiveness; train coaches rigorously in motivational interviewing, an empathic, respectful, patient-centered, evidence-based approach to promoting healthier behaviors; provide ongoing support for coaches after 2 to 3 weeks of initial training; have receptionists ask patients to complete screening forms in waiting areas, then have medical assistants review completed screens and summon coaches to see patients with positive screens; use a data-driven quality improvement program to refine the workflow, maximizing the proportions of patients screened and of patients with positive screens who see health coaches; and adapt electronic health records to support BSI. Administering BSI in this manner can help primary care clinics make substantial progress toward achieving the quadruple aim and thriving under value-based reimbursement.

The American Journal of Accountable Care. 2018;6(2):e9-e14

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