Director’s Message

The Doctor of Behavioral Health, or DBH, is the culmination of Dr. Nicholas Cummings’ vision of creating a doctoral training program tailored to the emerging need for innovative behavioral clinicians to practice in primary care and medical settings. The DBH curriculum and practicum are designed to offer a unique blend of evidence-based behavioral interventions, medical literacy, health systems, and entrepreneurship skills that will meet the needs of the health-care, reform-driven marketplace. The explicit goal of this program is to graduate clinicians who can deliver and document interventions that produce clinical and functional improvement, patient and provider satisfaction, and cost-savings by decreasing overuse of medical resources and the cost of lost productivity to employers. We believe that an upgrade to a doctorate for master’s-level clinicians based on this unique foundation of skills will result in graduates being highly valued in a marketplace that is searching for cost-effective care.

The Need for Behavioral Care Provider Co-Location

The health-care crisis of escalating costs and shortages of primary care physicians is anticipated to be addressed in President Barack Obama’s cabinet on health-care reform. Across the nation, key advocacy groups have been lobbying for both increased clinical integration of medical and behavioral care and increased reimbursement for integrated primary care services. Health plans and the companies they contract with are spending millions of dollars on outreach programs designed to identify and intervene with high-cost, co-morbid medical and behavioral cases, largely through telephonic or web-based programs. Employers are increasingly looking to health plans or private companies to offer interventions to reduce the high cost of absenteeism and disability related to behavioral conditions in the workplace. Within primary care, the demand for a team approach with a behavioral expert is clear as primary care physicians lack the time and expertise to deliver evidence-based behavioral interventions. The supply of behavioral clinicians who can meet this emerging demand is small. The ability to consult with primary care medical staff in the language of primary care, to deliver brief, stepped care interventions that “fit” primary care, and to document both clinical improvement and cost-savings for health-care payers—the hospital or physician group, health plan or employer—are not typically part of graduate training. The DBH program core competencies are founded upon these new needs of the 21st Century health-care system.

The Challenges of Being the First

There is no other program like this in the country. While existing programs offer integrated-care courses or certificate training, none is based on the integrated-care model developed by Nicholas Cummings that combines these medical, behavioral, health systems, and entrepreneurship skills so seamlessly. There are challenges to face in being the first program. The first was met in partnering with Arizona State University. ASU is recognized as a New American university founded on transforming society, entrepreneurship, transcending academic disciplines, community partnerships, and global engagement. The DBH program will be integrated with existing cutting-edge degree programs such as Nursing and Healthcare Innovation, the Medical School and the Doctorate in Physical Activity, Nutrition and Wellness. We will be based in new, state-of-the-art facilities on the ASU Downtown Phoenix campus working side by side with future physicians, nurses, and other allied health professionals who share a commitment to integrated behavioral care. Our faculty combines the best ASU core faculty with part-time adjunct faculty teaching courses in areas in which they are working full-time outside of the university. We are working closely with the Office of Clinical Partnerships to offer practicum experience in primary care settings that also support the university commitment to interdisciplinary collaboration.

The challenge of accreditation was met by our partnership with the National Alliance of Professional Psychology Providers (NAPPP), a large national advocacy group for practicing psychologists. NAPPP has a long-standing commitment to integrated behavioral care and formed a new National Institute of Behavioral Health Quality in order to offer standards and guidelines to behavioral clinicians from many disciplines. The challenge of achieving licensure for a brand-new doctorate will require a state-by-state strategy. Many of the most innovative components of our training program—medical literacy, stepped care and e-health, entrepreneurship and distance learning—simply are not part of existing behavioral license guidelines at this time. However, there is recognition of the need for licensing boards to address these issues. In addition, the leadership of Dr. Nicholas Cummings, the NAPPP, and many other champions of integrated care are expected to lead to initial and eventually widespread adaptation of licensing standards across the country. We are committed to developing a program that will be robust in meeting the quality standards expected by accreditation and licensure bodies. We will develop best-practice curriculum, practicum, and distance learning guidelines that will help write the book for those who follow.

The DBH program is explicitly designed to improve the earnings potential of our graduates. There are challenges to reimbursement for behavioral intervention in primary care. The reason for starting our program with a cohort of students with an existing master’s degree and licensure is to ensure that our graduates can receive traditional fee-for-service reimbursement in primary care and medical settings. We are hopeful that the many advocacy groups lobbying for improved reimbursement in primary care will impact the next rounds of health-care reform. However, it is important to note that in the real world there are already a multitude of innovative payment arrangements that our graduates may take advantage of. Physician groups and hospitals often have pay-for-performance incentive contracts that offer bonus payments above and beyond traditional fee-for-service reimbursement. Health plans are currently paying millions of dollars for case management and related programs that attempt to outreach high-cost patients with behavioral and medical co-morbid conditions. Employers in turn are paying health plans or other companies to provide behavioral interventions that will decrease the billions of dollars of annual lost productivity and disability caused by behavioral conditions. It is notable that many of these disease-management programs are under increased criticism for failure to deliver expected cost savings due in large part to relatively low-engagement rates for members they try to contact by phone, mail, or e-mail. We believe that the co-located behavioral clinician will have much higher engagement rates with patients because they are working with the primary care physician, whom the patient trusts, in a setting that patients find convenient. Our graduates will be able to capitalize on this advantage and be ready to present, implement, and demonstrate the “return on investment” for their services and to leverage that value added for enhanced compensation in the marketplace.

Conclusions

I am very proud and excited about the launch of this program with the support of Dr. Nicholas Cummings and the Arizona State University faculty. I have enjoyed talking with many interested students to date, and I welcome continued feedback so that we can continue to refine our program that reflects our commitment to excellence, the emerging marketplace needs, and the needs of our potential students.

Dr. Ronald O’Donnell
Director, Doctor of Behavioral Health Program