by Rick Ybarra
Over the past decade, there has been significant momentum to advance integrated health care (IHC) as a standard of practice in health care delivery. Integrated health care is the systematic coordination of physical and behavioral healthcare. Studies have shown that integrated health care approaches, such as the Collaborative Care model are more effective than usual care for depression, anxiety disorders and more serious conditions such as bipolar disorder and schizophrenia.1
In 2006, the Hogg Foundation for Mental Health began funding integrated health care through a three-year, service initiative grant program to bring the “collaborative care” model of integrated health care to several clinics in Texas. The model proved so successful that most of the grantees continued using it after the grant ended. Since then, the foundation has funded a comprehensive integrated health care resource guide; statewide learning communities to bring organizations together for shared learning opportunities to advance integration; and a major statewide integrated health care conference. In addition, we partnered with the U.S. Department of Health and Human Services Office of Minority Health to explore integrated health care as a strategy to eliminate health disparities. This effort resulted in two major reports and a comprehensive literature review (http://www.hogg.utexas.edu/initiatives/integrated_health_care.html).
In 2012, the foundation awarded 11 grants to nonprofit community-based providers to either begin a planning process to adopt an integrated health care program or for providers who had completed a planning process to begin or expand on the implementation of their project. The aim was to increase the number of nonprofit behavioral health and primary care providers delivering integrated health care with the goal of making integrated care standard practice in Texas.
What We Have Learned
Through site visits, evaluation reports and hearing first-hand accounts/reports from grantees, there’s a great deal we’ve learned about integration. We have learned that true and successful integration:
- Begins with collaboration (bringing community partners together; how resources are brought together) and moves through co-location and increasing levels of integration (how services are redesigned and delivered).
- Begins with thoughtful planning processes to (1) allow organizations to conduct a readiness assessment; (2) have meaningful dialogue with staff, community stakeholders and other community health care partners; (3) inventory the human and collective assets; (4) align or realign resources; and (5) have external consultation if needed. The result is an implementation plan with a purposeful goal of outcomes designed to achieve a level of integration.
- Understands that having a common lexicon of integration is important to have shared understanding.
- Realizes that team-based care is superior to individual practitioners providing services in a fragmented manner.
- Knows that screening for mental health and/or behavioral health conditions is essential to completing a comprehensive assessment; it is only then that historically unidentified behavioral health conditions are now identified and can be treated.
- Has a point person to serve as care coordinator, which adds tremendous value to effectively monitoring and managing the overall coordination of care the person receives.
- Delivers training on IHC (definition; models; components; go-to resources) enhancing competencies and helping integration take root within organizations.
- Develops and implements workflows for practitioners to follow offers the best chance for the workflow or process to be successfully “integrated” into the practice.
- Understands that a shared record system is integral to effective coordination of care.
- Recognizes that platforms such as learning communities bring providers together to support shared learning and promotes the spread of integration throughout the state.
- Provides evaluation support to help providers think more objectively and honestly about their goals, objectives and the intended impact of their work.
- Has metrics to determine whether programs are having real impact on health outcomes. Is the health status of the people being served improving?
- Recognizes that local, state and national policy that supports programmatic and payment reforms must be established in rule and in statute to drive systemic change towards integration in health care.
Most of all, we have learned that for integration to succeed, it takes people and commitment. People who are committed, willing to embrace a new way of doing things, and stay the course despite the challenges that organizations face when implementing a new program or service. Organizational change on its own is hard. Policies and funding are important, but without people and commitment, such efforts fall by the wayside. Integrated health care works! So let’s bring it on!
1. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. (2012). Collaborative Care for people with depression and anxiety. Cochrane Database of Systematic Reviews. http://summaries.cochrane.org/CD006525/DEPRESSN_collaborative-care-for-people-with-depression-and-anxiety