Behavioral Health – Primary Care Integration: Establishing the Mission of the Partnership

Community behavioral health organizations and Federally Qualified Health Centers (primary care organizations) are very mission driven.  There are numerous similarities between the two.  Each is focused on healthcare, serves as safety net provider, and serves people who are uninsured or underinsured. However there are differences as well, as you might expect.  Behavioral health organizations employ psychiatrists, psychiatric extenders, psychiatric nurses, psychologists, counselors, and social workers, and focus primarily on the recovery model. While primary care organizations employ family practitioners, physician assistants, nurse practitioners, medical assistants, nurses, certified nursing assistants, and focus primarily on the medical model. Very different philosophies and cultures. Therefore, it is vital to pay close attention to the partnership when developing a behavioral health – primary care integration partnership. Too often partnerships between the two stumble or perhaps even fail because of neglecting to address some key differences.  As discussed in the last post, for a successful behavioral health – primary care partnership, it is imperative to focus on building the relationship from the onset.  We will explore the steps that were adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June 1998. Vol. 18 . No. 3, in this and future posts.

ESTABLISH THE MISSION OF THE PARTNERSHIP 

Shared Vision

Each organization comes to the partnership with its own mission. It is a mistake to assume that the two separate missions are adequate to drive the partnership to success. It is vital for both organizations to sit down together and create a shared vision for the partnership. This will likely require a merging of goals into a partnership mission statement, comprised of elements in which each partner finds value. The mission statement serves as an anchor and roadmap for the partnership, ensuring that everyone is on the same page and heading in the same direction. This process should not be rushed, allowing time for the expectations of each partner to be explored so that the mission of the partnership can be negotiated. Best results occur when input is obtained from the various stakeholders at all levels. A statement that is meaningful to everyone is most effective. It should be clear, concise, and easily understood.

Communicate

Once the mission of the partnership has been determined, it is important to communicate it widely and often. This helps to clarify the mission and keep everyone on track.  It must be communicated with everyone involved in the partnership. Employees at all levels within the partner organizations are vital for success. This includes respectfully taking the time to listen to suggestions, comments, and complaints from all levels, responding accordingly. Touching base with everyone on a regular basis, trouble-shooting, providing feedback, and reassurance assures open communication and greatly increases buy in.

Frontline Champions

The success of the partnership’s mission will depend on frontline champions. In a behavioral health – primary care partnership, the frontline champion might be a nurse, an office manager, a clerk, etc. They need to be identified and empowered from the onset. Your champions provide the energy to motivate the other team members. Rest assured, your project will not succeed without these vital members of the team, serving as cheerleader and providing the enthusiasm and energy necessary to infiltrate the attitudes of the skeptics. The frontline champions help to give substance to the mission, allowing others to gradually begin to see it as well.

Establishing the mission of the partnership is a fun process that begins with two disparate organizations and along the way, creates another unique entity. This third entity is more than mere subsets of the two organizations joined together. It is a new creation with distinctive elements. It is greater than the sum of its parts: It is an Integrated Partnership.

Next time we will explore the importance of identifying a common language for our newly created integrated partnership.

Successful Behavioral Health and Primary Care Partnerships

I am happy to see that there are numerous initiatives underway to address the primary care needs of people with behavioral health disorders. It is heartwarming to see the silos begin to develop cracks, allowing the primary care folks and the behavioral health folks to engage in conversations about how we can work TOGETHER to serve this vulnerable population.

It isn’t easy for two disparate groups to work together.  It takes considerable planning!  Despite the fact that primary care and behavioral health are both healthcare fields, they have vast differences.  The culture, funding streams, philosophy, and overall approach to treatment vary greatly. Therefore, it is not an easy task for these two groups to establish a collaboration for serving the folks with behavioral health disorders….yet they are doing just that!  The mission is bigger than the differences! It is worthwhile to focus on ways to streamline the integration process.

For a successful behavioral health – primary care partnership, it is imperative to address these eight steps that were adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June1998. Vol. 18  No. 3:

  1. ESTABLISH THE MISSION OF THE PARTNERSHIP
    It is vital for both organizations to sit down together and create a shared vision. This will likely require a merging of goals into a partnership mission statement. This mission statement must be communicated with everyone involved in the partnership. The success of the partnership will depend on frontline champions.  They need to be identified and empowered from the onset. They will provide the energy to motivate other team members.
  2. IDENTIFY A COMMON LANGUAGE
    Primary care and behavioral health speak different languages; therefore, a common language must be identified.  Clarity of communication enhances mutual understanding of cultures, roles, and expectations.  While these differences might not seem important at the onset, it will become increasingly important as the partnership progresses.  Most likely, each partner has a different language for many things. There are notable differences between contract deliverables, medical records,  coding, management structure, procedures, and even the language used in describing the clients/patients/consumers/members served.
  3. MAINTAIN PACING, FLEXIBILITY, AND CAPACITY
    It is very important to temper expectations within the partnership. Establishing regular meetings will help to promote ongoing communication. Mutual goals and disappointments should be continually communicated so that they can be addressed immediately. The partners must remain flexible in order to sustain a healthy partnership.
  4. DEVELOP SHARED SOLUTIONS
    The decision makers must be open to new ideas and problem solving. Developing shared solutions maximizes organizational efficiency and capacity. Everyone must have skin in the game! Compromise is important for success.
  5. DETERMINE EXPECTATIONS
    The project should first be piloted to allow for evaluation and for adjusting expectations to ensure that both partners are on the same page. Internal conflicts are inevitable and should be discussed openly.  The partners must address differences of opinions on an ongoing basis. Partnerships create an opportunity for enhanced outcomes through blending of resources to maximize the capacity of each organization.
  6. DELEGATE TRUST
    Face-to-face meetings are essential to establishing and maintaining trust among partners. Be sure to focus on building trust at all levels.  Face-to-face time creates a forum for maintaining checks and balances to ensure fidelity to the mission. Constantly solicit feedback from partners at all levels.
  7. CREATE EMPOWERMENT
    Success is dependent on the involvement of everyone. This requires empowering champions at all levels to move the mission forward.  This empowerment develops buy-in among staff. Communicating with everyone and soliciting feedback ensures ongoing focus on the mission. Be sure to create a forum that allows both positive and negative feedback.
  8. MEASURE OUTCOMES
    Establish the outcomes to be measured early in the project. Be prepared to modify outcomes as needed. Don’t overlook the benefits of partnership that include more efficient allocation of resources, less duplication of services, increased choice among clients, and the synergistic effect of the partnership resulting in enhancing the lives of those we serve.

Following these eight steps helps to bridge the differences between behavioral health and primary care to ensure a successful partnership. Many partnerships have been derailed due to poor communication and lack of planning.  Careful preparation at the onset will ensure a productive partnership that will ensure a focused mission to address the health disparities among people with behavioral health issues.