The recent emphasis on whole person care has led a growing number of health care organizations to implement integrated care models. By integrating primary and behavioral health care, these organizations have discovered that they’re able to improve health outcomes, reduce the costs of caring for individuals with multiple conditions, and ease the entry of patients into needed behavioral health care that would have been be difficult otherwise.
With evidence linking poor physical health with poor behavioral health, and vice versa, and provisions in the ACA and the NCQA’s PCMH program, it seems likely that some form of integrated care is going to become the norm for health centers.
Levels of Integrated Care
Listed below are HRSA’s 5 levels of primary care/behavioral healthcare collaboration:
- Minimal Collaboration: Providers operate in separate facilities, have separate records systems, and communicate sporadically.
- Basic Collaboration (Distance): Providers have separate systems at separate facilities but engage in occasional communication (via phone or email) concerning shared patients.
- Basic Collaboration (On-Site): Providers are from separate organizations with separate systems but share a facility.
- Close Collaboration (Partial Integration): Providers within one organization who share a facility, have regular face-to-face communication, coordinate prescribing activities, and have some common systems (e.g., scheduling, medical records).
- Close Collaboration (Full Integration): Providers within one organization who are part of the same team, have regular meetings, coordinate prescribing activities, and have shared systems, including electronic health records. In this model, behavioral health treatment is provided as part of regular primary care.
More information concerning integrated care can be found on HRSA’s Technical Assistance page.
Integrated Care for Primary Care Providers
Implementing an integrated care model may seem like a daunting task, especially if you’re envisioning going from no integration at all to full integration. Our experience suggests that most health centers start out small when developing integrated care. This could mean implementing SBIRT, hiring a Care Manager or expanding the duties of a current on Case Manager, resolving reimbursement issues, and/or working with a behavioral health provider to offer telebehavioral health services.
Integrated Care for Behavioral Health Providers
Individuals with serious mental illness (SMI) are often struggling with various physical health problems. Unfortunately, it is often difficult to get these individuals to follow through with referrals for primary care services. As such, many behavioral health providers are finding that it is important to make primary care services easily available to their patients. From bringing in a medical provider for a few hours each week to hiring full-time primary care staff, many behavioral health providers are finding that offering some level of integrated care is resulting in better patient outcomes.
Given the emphasis that is being placed on integrated care, it is in your best interest to begin thinking about how it might be implemented in your organization. If you’re unsure of where to begin, have a plan in place, or are somewhere in between, we would be pleased to speak with you.
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