Hope Found: Enhancing Primary Care Mental Health

The US is amidst an unprecedented mental health crisis that is impacting patients of all ages, as well as the primary care clinicians who serve on the front lines treating patients. The impact of the pandemic, rising levels of chronic illness, a beyond frustrating healthcare system, polarization across the country, and the perpetual cycle of traumatic events streaming across all forms of media have ushered us into our current reality.  

At the same time, we face clinician shortages in primary care and psychiatry that are projected to get worse in the coming years. Primary care teams are often under-resourced, receive limited training in mental health, and are time-constrained with each patient so referring out is seen as the next step for the patient. However, current wait times for patients to see a mental health professional range from 24-48 days, depending on your geography. For a patient who is suffering from a mental illness, that can feel like a lifetime. For an already strained healthcare system, these lengthy delays in patient care compound healthcare costs, increasing the likelihood that patients will receive more expensive treatment options or hospitalization.

So how do we address the seemingly insurmountable feat of improving the state of mental healthcare today? We have to innovate to find ways to work smarter. And, we have to believe that we can create practical, scalable lasting solutions that will slowly, but surely, chip away at this massive challenge. At RubiconMD we are working with our primary care clients to create more proactive workflows with virtual specialists to speed access to behavioral healthcare. 

Some of the ways we are increasing collaboration between PCPs and mental health professionals are:

Episodic Psychiatric eConsults

Psychiatric eConsults empower primary care clinicians to get input on a patient case within hours. When a PCP knows they can treat a patient within primary care with the support of a psychiatric insight, or an in-person specialist visit isn’t feasible for the patient, this is an ideal option to improve the care plan and deliver more convenience for the patient.  

Proactive eConsults 

Several of our clients have implemented an eConsult-first workflow for certain patients needing mental healthcare. When a primary care patient meets specific clinical criteria, for example, PHQ-9 within a certain range, a member of the care team is encouraged to submit a consult to a virtual psychiatrist. This creates consistency in the screening, treatment, and management of patients with behavioral health disorders.

eConsult Collaboration

RubiconMD eConsults offer a collaboration feature where all members of the care team can be given access to draft, submit, and review eConsults. This shifts the admin burden away from the PCP and enables them to stay focused on the patient, using insights from the psych eConsult to inform the care plan. Team members like a nurse or medical assistant can help to facilitate getting a psych recommendation on the case with minimal additional work for the PCP while keeping the patient in primary care.  Or, existing mental health clinicians can use the collaboration tool to communicate with a psychiatrist to improve their diagnostic skills and support the PCP with medication management with a team-based approach.