Integrated Care

Integrated care has become a hot topic among healthcare professionals, and behavioral health providers play a vital role in this growing movement. The roll out of the Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) means that 60+ million Americans now have greater access to mental health and substance use care and treatment. With less than half of the 50 million Americans with mental illnesses receiving care,  integrating behavioral healthcare with primary medical care can jumpstart the growth in Americans getting the behavioral healthcare they need. Before that can happen, both primary and behavioral healthcare providers need the technology, frameworks, government support, and funding to make integrated care a reality.

16.-Collaboration

What Is Integrated Care?

Integrated care is the collaborative effort by healthcare professionals to provide clients with a comprehensive treatment plan. It involves shared communication and authority about treatment decisions, and it aims to address the whole person. The goal of integrated care is to provide holistic prevention and treatment that addresses a client’s biological, psychological, and social needs. According to the American Psychological Association, the “triple aim” of integrated care is improving patient access, quality of care, and cost effectiveness.

Physical Integration

One approach to this model is to physically integrate behavioral health and primary care. This approach can be found in primary care settings, specialty settings ( such as pediatrics and neurology), and other settings, such as long-term care facilities, community-based health centers, and social services sites. Behavioral healthcare teams often work onsite in these scenarios. There are advantages to housing behavioral health and medical services in the same place. Doing so can increase the chances that clients follow through on a referral. It also gives health providers the opportunity to grow their skills and network in house.

Integration Through Technology

However, physical integration doesn’t need to be the only approach to this model of care. Healthcare teams can meet the definition of integrated care as long as they share care plans and workflows. Health Information Exchanges enable patients and professionals to securely access medical information electronically. Behavioral health providers and primary care providers can take advantage of interoperability to securely share data with other healthcare professionals in an individual’s circle of care.

The Cherokee Health Systems is one example of a successful integrated care model. The CHS is a federally qualified health center and community mental health center where clients’ needs are evaluated across the board, and all issues are addressed in one place. They focus on low-income and underserved populations, and as of 2018, were providing care to 78,600 individuals. The system has grown to 48 clinical locations across Tennessee. Their model is characterized by shared delivery of medical and behavioral care, the assurance of behavioral healthcare at any visit, expanded health management, and support for patient engagement.

What Are The Benefits of Integrated Care?

Improved Outcomes

According to the Agency for Healthcare Research & Quality, research increasingly shows that integrating behavioral health improves diagnosis time, cost-effectiveness of treatment, and—most importantly—client outcomes. Integrated care has the potential to bridge gaps in diagnosis, and it increases the chance of treating comorbid mental health issues. Plus, it’s often more convenient for clients.

Separate systems of care can result in misdiagnosis, late diagnosis, or uncoordinated treatment plans. Integrated care can improve the accuracy and timeliness of diagnosis and treatment. Clients participating in integrated care are also able to decrease their overall healthcare costs by addressing behavioral health issues at the same time as any medical issues.

Client Comfort and Convenience

In addition to improved outcomes and decreased costs, clients are more likely to follow through with treatment for comorbid health issues when they have access to a “one-stop shop” for healthcare. Clients who would be hesitant to seek out behavioral health treatment alone are able to receive care in a familiar setting.

Expertise Sharing

Finally, integrating behavioral care and primary care creates a deeper pool of expertise. Primary care providers have access to behavioral health professionals who can fill in the gaps where they lack time or training. Having a diverse set of professional skills in one setting can lead to better treatment plans.

What Is The Current State of Integrated Care in the U.S.?

In the past, behavioral health systems, funding, and laws have been structured apart from the medical health field. In order to integrate, a lot needs to change, including funding and policy changes that help providers accurately bill for their services. The industry is moving towards value-based care and alternative payment models, which should help incentivize providers to coordinate care in the most efficient way possible.

SAMHSA has launched the Strategic Initiative on Health Care and Systems Integration (SIHCSI) to improve the integration of behavioral health and physical health services. This initiative aims to increase access to services, improve the coordination of care across fields of heath, and improve health outcomes without driving up costs. SAMHSA even hopes that integration will eventually address social determinants of health, like safe housing, equal access to healthcare, transportation, and employment.

Interoperability and client access to health information are keys to providing successful integrated care. Providers need to have the ability to share information with Health Information Exchanges, with other providers, and with government entities. Improving protocols for sharing information and refining the rules against information blocking will help enable this kind of data sharing. Lastly, individuals need to be invested and empowered in their own care by having access to their health information and records.

Coordinated Behavioral Care (CBC) consists of a Health Home that provides care coordination to tens of thousands of New Yorkers, as well as an Independent Practice Association (IPA) that represents a partnership of over 50 health and human services organizations throughout NYC.

As a Health Home, CBC provides comprehensive care management for children and adults in New York. The Health Home program provides integrated care and care coordination services to individuals who receive Medicaid and also have a serious mental illness, HIV/AIDS, or 2 or more chronic medical conditions. CBC’s care managers work with a full range of providers within their members’ communities: including hospitals, community medical and mental health clinics, substance use treatment programs, and housing services. By factoring in social determinants such as food scarcity and lack of social support, CBC’s care managers support individuals in managing their behavioral health and/or chronic conditions.

One of the reasons that CBC’s integrated care models have been so successful is the recognition that there can be multiple types of integrated care. Traditionally, integrated healthcare has brought social workers and mental health clinicians into the primary care setting. But, for individuals with severe behavioral health conditions, CBC has recognized that the first contact point with the healthcare system for these individuals is often a behavioral health provider, not primary care. Recognizing that behavioral health can be an individual’s entry point into the healthcare system, CBC realized that “reverse integration,” where doctors are brought into behavioral health settings, can be even more effective in some cases.

CBC has also leveraged technology and their care management platform to better understand the needs of its members. By producing geomaps of all the services under their Independent Practice Association (IPA), which includes food pantries, shelters, and Article 31 clinics, they can understand whether there are gaps in their network. They also conduct surveys of their community to ensure that they have available care managers that speak the languages of their culturally and linguistically diverse member population.

Above all else, CBC focuses on member engagement. If a member is struggling to make their mental healthcare appointments, care managers will look at all the potential reasons for this -- whether it’s lack of transportation, lack of childcare, or a healthcare condition. CBC understands that successful integrated care is not simply a merger of behavioral health and primary care. It’s the ability for all providers to account for a person’s unique life circumstances in order to help them better manage their conditions.

What Are The Next Steps for Behavioral Healthcare Providers?

The shift toward integrated care has already begun, and there are many tools for providers who want to take the first step:

Interoperability and client access to health information are keys to providing successful integrated care. Providers need to have the ability to share information with Health Information Exchanges, with other providers, and with government entities. Improving protocols for sharing information and refining the rules against information blocking will help enable this kind of data sharing. Lastly, individuals need to be invested and empowered in their own care by having access to their health information and records.

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