Flow chart with gapsA fellow colleague, Robert Ferguson of the Pittsburgh Regional Health Initiative, recently posted a Health Affairs blog post commenting on an October 2014 Health Affairs article titled, “Few ACOs Pursue Innovative Models That Integrate Care for Mental Illness And Substance Abuse With Primary Care,” in which the authors stated that the quality measures in an Accountable Care Organization’s (ACO) contract affect how well that ACO integrates behavioral and physical health integration. The authors in this article further noted that implementing measures such as depression screening and other screening tools could lead to further treatment improvement. In Robert’s post, he proposes not only additional measures but challenges the view that screening protocols and measures alone will be sufficient to create a health care paradigm shift and advance integrated care models to achieve the Triple Aim: improved population health, patients engaged and satisfied with their treatment, and care delivered at a reduced cost.

Robert articulates what many of us have spent considerable time thinking about. I call it the “white space” in between the program implementation steps that either lead to successful implementation or derail these efforts. Flow charts and process maps give us direction. But it goes way beyond instituting the key components of integrated health care. In many ways, that’s the easy part (such as deciding to institute screening measures). The challenge for health care providers and health care systems is what happens (or doesn’t) in between the implementations steps. Robert’s post highlights that effective implementation of integrated health care calls for “systemic requirements” that support successful implementation efforts. Definitely worth the read!

And whatever process map or flow chart tool you use to illustrate your implementation plan, pay attention to the white space. That’s often where implementation efforts succeed…or fail.