Tag: behavioral health integration

VISION: The First Key Component of a Successful Behavioral Health and Primary Care Marriage
behavioral health integration · behavioral health primary care integration · collaborative care · health disparities · healthcare integration · mental health · primary care behavioral health integration

VISION: The First Key Component of a Successful Behavioral Health and Primary Care Marriage

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Every relationship follows a similar pattern. The early phase begins with the selection of a partner. The same holds true for the integrated behavioral health and primary care partnership. It may begin with running into each other at a meeting. Or perhaps while reading the lastest report on the emerging trend of healthcare integration, Accountable Care Organizations, health homes, etc…

The Vision begins to form                          

The behavioral health and primary care clinics enter into the dating relationship when the leaders of each, who have mutual admiration for each other, begin to recognize the potential of doing business together. One leader calls the other, suggesting they get together for lunch. It’s only lunch, he rationalizes to himself, it doesn’t mean anything…there’s no harm just in talking….

One thing leads to another during the wooing and courting phase; soon the idea transitions and the outline of a plan begins to emerge. The two leaders have entered the early stages of the partnership. The Vision is being created, becoming a driving force for each.

The two organizations soon find themselves having serious discussions about forming a partnership. How did THIS happen?? The proposal is followed with a flurry of planning. There are so many details! Attorneys are kept busy creating a business plan and reviewing financial and regulatory documents, planning for the wedding of two organizations. Decisions must be made of how the assets are to be shared. Finances are sorted, MOUs are signed, and the partnership is official.

The marriage of behavioral health and primary care creates a unique entity that is far greater together than either had, or could have been, alone.

The early stage of the partnership is filled with excitement as the Vision takes shape and becomes reality. The shared vision is driven by the passion to become what neither can achieve alone. The specialty behavioral health provider and the primary care provider have integrated, raising the bar of healthcare for people with behavioral health disorders.

This marriage of healthcare providers is based on a Vision shared by two of eliminating the health disparities of people who suffer from serious mental illness and substance use disorders.

Next time we will explore the second key component of a successful behavioral health and primary care marriage:  Communication.

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Behavioral Health – Primary Care Integration: Choosing a Model

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Which Models Work Best?

There are several model programs for behavioral health and primary care integration in the United States that are currently demonstrating outstanding results, such as Cherokee Health Systems, Intermountain Healthcare, and Washtenaw Community Health Organization. However, to quote Dale Jarvis, of Dale Jarvis and Associates, a national consultant specializing in payment and reimbursement system redesign, financial modeling, and business systems design for healthcare purchasers and providers: “All healthcare is local.”  Behavioral health – primary care partnerships can learn much from the model programs but will need modification to meet the unique needs of their communities. A model that is successful in a rural community may not be effective in an urban setting. State regulations greatly impact the success of various models as well, especially if the model relies heavily on funding sources that may have significant differences from state to state.

The promotion of  behavioral health and primary care integration has been identified nationally as holding promise for improved health outcomes and increased efficiency in the use of healthcare dollars. The United States Department of Health and Human Services, (HHS)  is funding 56 Primary and Behavioral Healthcare Integration (PBHCI) projects in an attempt to identify effective means of integrating healthcare. HHS, in collaboration with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), seeks to answer three questions about the integration of primary and behavioral healthcare, as noted in this excerpt from the 10/21/10 SAMHSA webinar, Primary and Behavioral Healthcare Integration by Trina Dutta:

  1. Outcome Evaluation: Does the integration of primary and behavioral health care lead to improvements in the behavioral and physical health of the population with serious mental illness (SMI) and/or substance use disorders served by the grantees’ integration models?
  2. Process Evaluation: Is it possible to integrate the services provided by primary care providers and community-based behavioral health agencies (i.e., what are the different structural and clinical approaches to integration being implemented)?
  3. Model Evaluation: Which models and/or respective model features of integrated primary and behavioral health care lead to better mental and physical health outcomes?

(Contractor: RAND Corporation)

In a collaborative effort between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) a training and technical assistance center, the Center for Integrated Health Solutions, is available for PBHCI grantees and other organizations that are integrating behavioral health and primary care services. The Center for Integrated Health Solutions is a division of the National Council for Community Behavioral Healthcare.

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Behavioral Health – Primary Care Integration Partnerships: Delegate Trust

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The delicate subject of trust is the focus of this installment in the series devoted to creating a healthy integrated partnership between behavioral health and primary care. This has been 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.
 
DELEGATING TRUST
 
Trust is necessary to overcome expected conflict
When team members of the behavioral health and the primary care organizations come together for an integrated partnership, typically everyone is on their best behavior. It is easy to have a harmonious relationship at this stage. However, when conflict first intrudes, particularly regarding shared goals and outcomes, the amount of trust between partners can make or break the partnership. Create the forums at the onset to maintain a system of checks and balances. 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. The transparency also breeds trust.
 
Focus on building trust at all levels
It takes a significant amount of trust for a person to commit to any partnership; the behavioral health primary care integrated partnership is no different. Often the partnership is created when two leaders, most likely chief executive officers of the organizations, decide to bring together their collective expertise. The two CEOs build upon their mutual shared experiences of serving on committees, community boards, etc. together. They travel in similar circles and have developed reciprocal trust and respect. Unfortunately, a frequently overlooked aspect of this process is the fact that the managers and frontline staff who must join together to make the collaborative partnership a reality have NOT had the opportunity to develop that same level of trust. The wise leader recognizes the importance of building the trust necessary for a solid foundation between partners. Trust does not automatically filter down. Devoting considerable face time during the planning stage aids in establishing a firm foundation of trust. Dedicated time for regular interaction (weekly/monthly meetings, conference calls, etc.) helps to maintain the connection. Maintaining the flow of communication helps everyone to stay current with expectations and reduces the chance of surprises, which can quickly erode trust. Bringing together staff with their counterparts allows for those relationships to develop separately in addition to the collective partnership/relationship. It also allows issues and solutions to be addressed at the appropriate level. Medical Directors must communicate with Medical Directors; nurses communicate with nurses. When the CEOs communicate with each other in their decision-making process, they will benefit from the solidarity among the matched pairs in gathering input. Making informed decisions prevents leaders from forcing issues and promotes the trust that is so vital to success relationships.
 
“The glue that holds all relationships together – including the relationship between the leader and the led is trust, and trust is based on integrity.” –Brian Tracy
 
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Behavioral Health – Primary Care Integration Partnerships: Determining Expectations

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The majority of integrated partnership failures occur due to irreconcilable differences.  This step focuses on the sensitive issue of the compromise on expectations.

This fifth installment of vital steps for creating a successful behavioral health – primary care partnership, has been 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.  

DETERMINE EXPECTATIONS

This step addresses the issue of the expected outcomes for the partnership, building upon the shared mission:

What results do you expect from the partnership?

Do your expectations coalesce with those of your partner?

Compromise is in order at this juncture. Chances are good that each partner will agree on some things, but not on all things. The most successful of partnerships will devote adequate time and energy at this point to identify mutually agreed upon expectations and how results will be measured. The partnership creates enhanced outcome opportunities. Open communication on an ongoing basis helps to keep everyone on track. Internal conflicts are inevitable and should be discussed openly. The partners must address differences of opinions on an ongoing basis to prevent resentments from building.

Partnerships create an opportunity for enhanced outcomes through blending of resources to maximize the capacity of each organization. The result is a synergy far greater than the individual components. The integrated behavioral health – primary care partnership is far more effective and powerful than the single behavioral health or primary care clinic.  Addressing all healthcare needs of the individual yields benefits that far exceed treatment focused only on behavioral health or primary care concerns.

Once the data elements are identified, collect a baseline before starting. The project should first be piloted to allow for evaluation and for adjusting expectations to further clarify the outcomes to be measured. Re-evaluate and respond. Time devoted to this process at the beginning will save considerable time, energy, and frustration further along in the project. With a solid framework of data elements, baseline, and data collection processes in place, outcome measurement will be easy to accomplish. Outcomes that are meaningful to the mission of the partnership will provide the guidance necessary for ongoing success.

 
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Behavioral Health – Primary Care Integration Partnerships: The Value of Shared Solutions

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The next step in the process of developing a successful behavioral health – primary care integrated partnership, is developing  shared solutions for the partnership. This is 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.

 DEVELOPING SHARED SOLUTIONS

When behavioral health and primary care organizations collaborate to provide integrated services, it is very important to develop shared solutions for success in the endeavor. For a partnership to meet the needs of all partners, the decision-making must be shared. The decision makers must be open to new ideas and problem solving. 

One of the most difficult tasks in a partnership is bringing two disparate organizations together, asking them to compromise for the good of the relationship.  All stakeholders traditionally are in favor of creating a shared solution…..as long as they aren’t the ones who are asked to make the change. This step requires taking the time to explore the areas in which the partners can make adjustments versus the areas that require strict adherence to the regulations of the organization.

This step in the partnership requires time to come to an agreement. Negotiations may take some time, but are worth the investment.  Everyone must have skin in the game. During the process of negotiating, the ideal end result will develop from compromise among all partners. Patience and understanding are vital at this point and will ultimately result in a shared solution if the partnership is viable. Shared solutions maximize organizational efficiency and capacity. It helps to avoid the “blame game”.

Healthy partnerships result from both give and take on the part of all partners. Compromise is important for the success of the partnership.  Partners have much more invested in the successful outcome when there is agreement on the ultimate mission.

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Behavioral Health – Primary Care Integration Partnerships: Identifying a Common Language

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A successful behavioral health – primary care partnership requires 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.

Integration of the partners requires a common language

Behavioral health and primary care professionals speak different languages. When the two organizations sit down to discuss the details of the partnership, everyone has stars in his/her eyes in anticipation of the wonderful things to come (and rightly so). However, many seemingly trivial matters are overlooked in the excitement. Identifying a common language between the partners is one such matter that is frequently overlooked.

Clarity of communication enhances mutual understanding of cultures, roles, and expectations

Mutual understanding of cultures, roles, and expectations sets the tone for a respectful, healthy partnership. Like any important relationship, honoring matters of importance to partners creates an environment of trust.

It is crucial to an integrated behavioral health and primary care partnership to clarify language differences and negotiate an agreement. While there are numerous commonalities among healthcare in general, specialty areas have a unique terminology as well. It is important to agree upon a language that all partners understand and agree upon. For example, there are notable differences between contract deliverables for behavioral health and primary care organizations. Failure to clarify this can potentially result in failure to meet targets.

A few examples of language differences:

  • What will the people who are served be called?  Patients, clients, consumers, members are some possibilities
  • The roles of the professionals vary among organizations and must be decided upon for the partnership
  • Medical records
  • Coding
  • Billing
  • Clinic flow
  • Management structure

Once the language has been identified and defined, patience is necessary as each partner adjusts to a new way of doing business. Patience, understanding, and ongoing compromise are key in the success of an integrated partnership.

Next time we will explore the importance of maintaining pacing, flexibility, and capacity in the behavioral health and primary care integrated partnership.

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

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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.