Tiered Model for Behavioral Health

Hi Fabulous PHLN Teams! We (Open Door) are considering implementing (or at least piloting) a “tiered” approach to BH, meaning we want to try having some of our clinicians use longer-term therapy interventions/services (vs. just short-term, solution-focused)… similar to Cherokee’s model. Anyone had success with this? If so, how did you handle it and what does the structure and workflow look like? How do you prevent access issues (therapists seeing patients for “too long”)? Are there financial implications to this model?

We have found that most BHC’s want to do multiple different things/modalities so as to avoid burnout in one area. Would folks recommend having all our BHC’s spend some time doing longer-term therapy or just have a few folks doing that specifically and all other BHC’s doing short-term, solution-focused? Thanks in advance for your help!

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Love that you’re testing out a model similar to Cherokee’s!

I’m tagging some teams that are working towards an integrated BH model that might be able to answer: @Afsheen_AXIS @Vista @NEMS.

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Hello Holly!

Great question. Here at Axis one of our goals is to build a registry for IBH, especially since we just went live with Epic and are planning to use new reporting tools and features to assist in this goal. I want to provide you with concrete answers, so I relayed your question to our Chief of Behavioral Health. I’ll follow up with you shortly. :slight_smile:


Hello Holly,

As promised:

"Here at Axis we utilize a tiered approach which has really improved morale among therapists and enables them to feel more independent in their approach. Luckily our funding isn’t impacted by the length of treatment as long as medical necessity is clearly documented.

Access to care can definitely be an issue when using this approach; however, we’ve worked hard to identify the right number of therapists to meet the demand and thus, have a pretty robust BH department compared to most departments. Additionally, we are looking at setting limits for the longer term counseling we provide in order to provide additional openings."

Hope this helps!



Hi Afsheen and Holly. You are right, finding the sweet spot in primary care for patient access to behavioral health and therapist joy in work requires a fine balance. Here is an example at Clinica in Colorado: they started by hiring people who were interested in applying brief models. Each behavioral health professionals (BHP) is on a team that serves a panel of approximately 3600-3800 patients. They also set expectations that longer term counseling for a single problem would not exceed to 6-8 visits. This allows the BHP space in their schedule for brief interventions such as SFBT and CBT for patient access. Applying this model, a BHP would start each day with 3-6 patients scheduled for 20 (or rarely 40) minute appointments, the rest of day is open to see patients coming into the team that day.