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More than half of the nation’s family physicians say they include nurse practitioners on their care teams, but admit they are lacking when it comes to working with behavioral specialists like psychologists and social workers.
A new analysis by the Robert Graham Center, an affiliate of the American Academy of Family Physicians, is the latest to show doctor practices and medical groups collaborating more with nonphysician providers. The trend coincides with value-based models of care like accountable care organizations (ACOs) and medical homes that are contracting with insurers to care for populations of patients.
The study showed 52% of family physicians are working with nurse practitioners and 39% of family doctors are working with physician assistants . But the research shows only 21% of family doctors working with behavioral specialists.
“Family physicians appear to be heeding calls to broaden primary care teams to better meet patient needs though behavioral health integration remains limited in family medicine and other disciplines,” said Dr. Andrew Bazemore, director of the Robert Graham Center for Family Medicine and Primary Care, which analyzed data from a survey of more than 11,000 doctors.
Doctors didn’t always welcome the help, but there is a primary care shortage as well as growing pressure from health insurance companies and government health programs to pay for performance. That means moving away from fee-for-service medicine that emphasizes volume and unnecessary tests and procedures to value-based care models that provide financial rewards when care is done right the first time, particularly in a primary care setting.
The Medicare health insurance program is shifting half of all reimbursement dollars to value-based care models by 2018. Private insurers like
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Having the care team include nurse practitioners, physician assistants and a behavioral health specialist in a care team is critical. Social workers, psychologists and therapists are key given studies show patients with myriad chronic conditions like high cholesterol, hypertension and heart disease also suffer mental illness.
“Teams make same-day scheduling, extended office hours and weekend appointments possible,” says Dr. Wanda Filer, president of the American Academy of Family Physicians. “That kind of care reflects the direction our healthcare system is taking--one that is moving toward valuing the quality and outcomes of care over the number of services provided.”
As one example, the Robert Wood Johnson Foundation has closely documented the problem of “super utilizers,” which are patients that often suffer myriad chronic conditions including mental illness and use emergency rooms multiple times over the course of a month or even a week. Incorporating behavioral health specialists into primary care teams can ensure mental health patients are taking their medications, getting to their providers and having their needs addressed to avoid costly hospitalizations.
“Primary care providers of multiple disciplines are working together to meet the needs of patients across the country,” said Cindy Cooke, president of the American Association of Nurse Practitioners. “Having multiple disciplines in a multipronged approach better meets the needs of patients everywhere. Insurers are beginning to recognize the benefit of mental health care and payor models are slowly increasing.”
Nurse practitioners are educated to perform myriad primary care functions, diagnose, prescribe medications and conduct physical exams. State scope of practice laws are increasingly changing to allow nurse practitioners to provide even more primary care even if they don’t have an agreement with an overseeing physician.
Mental health nurse practitioners comprise about 3.7% of all NPs and those numbers are increasing , Cooke said.
