Keck Medicine of USC

The BHN program created a clear pathway from primary care to cognitive assessment at Keck Medicine of USC, removing the burden on individual clinicians to initiate evaluation by providing a single order for referral. A dedicated weekly slot was held for BHN referrals to ensure timely specialty follow-up when indicated. The program catalyzed adoption of Principal Care Management (PCM) and Cognitive Assessment and Care Plan (99483) billing codes within the Department of Neurology. A cross-departmental steering committee spanning Family Medicine, Internal Medicine, Cognitive Neurology, and research, drove institutional conversations about improving integration of care for memory disorders. The program was also added to the Los Angeles County BOLD/Healthy Brain Initiative directory of early detection programs.

Successes included the formation of a multidisciplinary steering committee that initiated important between-department conversations about optimal care pathways, successful piloting of the Linus Health digital cognitive assessment with the intended primary care screening population, and engagement of the Keck coding team to explore and adopt new billing codes within neurology. Challenges included slow organizational processes that delayed BHN hiring and reduced project momentum, lack of clarity on documentation and consent requirements for new billing codes, assignment of digital cognitive assessment implementation to IT alone rather than an interdisciplinary group, and limited space available for clinical assessments. Billing pathways were not fully implemented in the timeframe of the project despite increasing referral momentum, but did stimulate active and ongoing discussions of implementation of care management codes across the institution.

The BHN model in its initial primary careform was ultimately determined not to be sustainable as a regular part of primarycare clinical operations. However, moving forward, the BHN program pivoted withelements of the BHN workflow being incorporated into USC's existing Center forPersonalized Brain Health (CPBH), where future referrals are now seen by anurse practitioner at the CPBH Prevention Clinic who performs a comprehensiveassessment, including cognitive testing and screening for contributing factors,and bills E/M codes, providing a sustainable reimbursement pathway. The Cernerreferral order was transitioned to the CPBH. A key lesson for the field is thatdeveloping a BHN program in a large academic system requires sufficient time toimplement substantial workflow and culture changes.