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Efficient care and high productivity are essential elements for behavioral health consultants (BHC) practicing the Primary Care Behavioral Health (PCBH) model. But there can be quite a bit of variability in how clinics measure quality and productivity.

Metrics can include the number of patients seen, the relative value of each intervention provided, or the patient health outcomes achieved per-dollar spent, among others. Clinics measure what they value, and it can be helpful to see what other clinics value.

Here is a recent report shared on the CFHA listserv from David Bauman and his team at Community Health Central Washington.

CHCW 2020 Data

David Bauman: Excited to be able to share our 2020 data!

As a reminder, our BHC team consists of 14 BHCs that equate to 8.35 FTE clinical coverage. These BHCs cover five primary care clinics throughout the central part of Washington state. We are a Community Health/FQHC. BHCs include four licensed psychologists, a social worker, a LMFT, three LMHCs, two doctoral fellows, and three doctoral interns.

We measure productivity via “clinics,” which is a four-hour half-day. We only include visits that meet the threshold of completing a Contextual Interview and an intervention being delivered, resulting in close to 100% of the visits being counted as billable visits.

Total Visits:

• 12,003 visits (increase of 1,460 from 2019)
• 4,401 initial visits
• 3,516 handoffs (decrease of 706 from 2019)
• 799 BHC visits paired with medical visit (decrease of 375 from 2019)

Visits Per Clinic:

• 4.4 visits per clinic (range 3.5 – 6.3) OR 8.8 visits per day (range 7.0 – 12.6); .2 per clinic increase from 2019
• 1.1 handoffs per clinic per BHC (range .6 – 1.8) OR 2.2 handoffs per day per BHC (range 1.2 – 3.6); .4 per clinic decrease from 2019

Total Patients Served and Penetration Rate:

• The BHC team saw a total of 4,472 unique patients in 2020
• Throughout the five CHCW clinics, the BHC team had a penetration rate of 21%, meaning over 1 out of every 5 patients that saw a medical provider, also saw a BHC in 2020
• At our largest clinic (CWFM), the BHC team achieved a penetration rate of 25%, meaning 1 out of every 4 patients that saw a medical provider, also saw a BHC in 2020
• BHCs averaged 2.7 visits per patient for 2020

Patient Satisfaction:

Patient satisfaction is done quarterly and each BHC has a total of six patients per quarter (24 per BHC) surveyed about their experience with the clinic/BHC visit (this survey is completed by an outside agency). Responses are converted to a composite score out of 100, the higher the score, the more satisfied the patient was

• Overall Satisfaction (which is measured by the patient’s TOTAL experience, i.e., reception, provider seen, pharmacy, etc.) was 91.7
• Loyalty Intentions (measured by the likelihood of the patient seeking services again at our clinic) was 97.6
• When compared to other provider groups at CHCW, BHCs were rated higher on the above categories

Provider Satisfaction:

Each year, PCPs rate the BHC department regarding the PCP’s satisfaction. Satisfaction is out of a 5-point Likert-type scale.

• Overall Satisfaction – 4.8
• Helpful for Patients – 4.8
• Helpful to the PCP – 5.0
• Patients Are More Adherent – 4.0
• BHCs make PCPs Job Easier – 4.6
• 77% of all PCPs said they use the BHC each day or most days when in clinic
• When asked what would lead to higher rates, 67% of the suggestions related to adding more BHCs

Some qualitative comments:

I have come to believe this brings more value to the care I can offer patients than any other service in our clinic.

I have come to believe this brings more value to the care I can offer patients than any other service in our clinic.

I have been here for 2 months and I couldn’t be happier with the service

10/10 would buy again! BHC is one of the best resources available to my patients!

In the future, I will never practice without a BHC partner on the team.

Financial Implications:

There are two Behavioral Health related department budget items, Behavioral Health Clinical Program and Behavioral Health Training Program. For the first six months into the 2020 fiscal year:

• The Behavioral Health Clinical Program had a substantial positive net revenue
• The Behavioral Health Training Program had a positive net revenue
• While grants support both programs, the Behavioral Health Clinical Program would have a positive net revenue on patient encounter reimbursement solely.