The nationwide movement to advance Integrated Health Care (IHC) as a standard of care continues!
It has been a mountain climb, but we have made significant progress over the past five to seven years moving incrementally towards the summit. To date, numerous studies indicate that people receiving IHC versus treatment-as-usual experience better health outcomes.
IHC makes sense. Health care delivery, although still fragmented, is certainly more coordinated and aligned today in the delivery of both physical health and mental health under the “one stop shop” approach. Clearly, it’s easier said than done. Some of the unique challenges include adoption of policies, the redesign of workflow patterns, embedding the MH/BH consultants, training issues, uptake of team-based care, redesign of physical space, and the financing of IHC (some more so than others). Steadfast leadership by the CEO, executive team and board can support a successful, organizational change management process. Yet there is an awakening at the provider, health plan, and systems level that, “Yes, this approach does contribute to improved health outcomes.” Most importantly, patients now want IHC! They see the benefits of receiving IHC versus usual treatment. So buy-in is there!
IHC is supported in the proliferation of local, state, and national reports and publications on the wide scale adoption, implementation, effectiveness and impact of IHC throughout the country. And although the cost savings studies are not as robust as we would like, IHC shows tremendous promise in achieving the Triple Aim:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations, and;
- Reducing the per capita cost of health care.
And let’s not forget improving the experience of providers too!
IHC effectively addresses the needs of people with complex health care needs. So to take this idea further, I’ll offer up some additional thoughts in four key areas: Organizational Change, Training, Financing, and Policy.
Organizational Change
In many ways, IHC is designed to support organizational change at the patient-provider encounter, at the provider level, at the organizational level, and at the systems level. You will be more successful if IHC is organizationally embraced, supported and adopted at all levels. This is probably the hardest to achieve: organizational culture change. Supporting the strategic implementation of IHC that promotes organizational and systemic change will enhance your chances of overall success.
Training
It’s not just about training a few specialists; it’s about developing competencies. In IHC settings, provider roles are re-clarified. Common questions include: “What does this mean for me as a provider? How do I work in a team-based approach? What is my role now and how do I do this differently in an IHC environment as part of my job?” It’s more than embedding or co-locating a behavioral health consultant or onboarding.
So how do we develop competencies? Promotion of practice change through modeling. Often we send staff to training and expect them to implement practice change upon their return. That’s just not realistic. Also, competencies are not just for individual health care providers but for teams that need to learn to work together and effectively to deliver quality, team-based care (e.g., learning how to work in a team-based approach; each team member’s role; how each team member functions; workflow patterns).
Financing
Sustainability of IHC requires major transformation in design, delivery & financing of health care. Complexities aside, in some ways there are no real tricks or fancy gimmicks to write this into policy, negotiated payment rates, or into rules, regulations, or national standards tied to funding. What is really required is political will.
Payors, whether health plans, governmental agencies, or foundations, are looking at the cost economics of care delivery. An important consideration if you are a provider organization.
Think about how to fund IHC within current resources/funding streams. Waiting for increased funding is the wrong approach! In my experience, the leading organizations are the ones who decided to “scale the IHC summit” early on and took on some of the financial (and calculated) risk. They are now the health care organizations leading the trek to the summit!
Outcomes! Build or redesign databases and collect the right types of data to demonstrate the outcomes you are aiming for. And don’t forget to build in the Continuous Quality Improvement/performance improvement feedback loop to serve as a reality check on “how it’s going” and make adjustments and corrections during the process. If you can show outcomes data that demonstrate improved health outcomes, you have better leverage and will help build your business case to payors to negotiate reimbursement of key IHC components or enhanced reimbursement rates.
To funders: you get what you pay for. Collaborate and negotiate with health care providers to deliver IHC. Be willing to reimburse key service components that promote IHC (e.g., care management; providing team-based care).
Are providers willing to take on risks? You may (or may not) be surprised to hear that more and more provider organizations are willing to assume risks. In many payment reform models, the ability to deliver effective care and produce improved health outcomes result in financial incentives to the provider organization. An IHC approach that delivers improved health outcomes will increase the likelihood of provider uptake of IHC and provider and health care organizations willing to bear increased risks.
Policy
Identify barriers at the local level and work to eliminate them. Identify systemic barriers, build the business case and mobilize other providers to advocate for the financing of IHC with funders/payors. Identify who is reimbursable and who is not. Identify what types of services are reimbursable and which are not. Is there an ingenious way to finance and bill for “team work”?
In closing, think high touch – low tech. Think value-based versus volume-based. Think health outcomes and population health. Think heath care system versus sick care system.
Be bold, be visionary, be a disrupter.
The bottom line is if you can demonstrate the ability to effectively manage care and achieve the Triple Aim, this will result in healthier people, healthier families, healthier communities and a healthier nation.
And so our trek towards the IHC summit continues…