Tag: behavioral health – primary care integration

Affordable Care Act · behavioral health integration

Behavioral Health Homes

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In the midst of talk of healthcare reform, it is apparent that the face of healthcare is undergoing numerous changes from the traditional delivery system. Accountable Care Organizations and other collaborative efforts are proving to be viable solutions for addressing the gaps within healthcare, providing a glimpse of its future structure. Efforts are underway across the nation (and internationally) to integrate behavioral health and primary services within the ACOs as well as between community behavioral health and primary care providers.

The Patient Protection and Affordable Care Act has created a health home option in Medicaid for treatment of chronic conditions. Thus, the concept of the health home was created, with incentives in place for a more holistic approach to healthcare in an attempt to improve quality of care, contain or reduce costs, and improve outcomes. With behavioral health conditions meeting the established criteria for chronic conditions, behavioral health homes are the ideal solution for meeting the needs of people with serious behavioral health disorders who have not traditionally accessed healthcare on an ongoing basis. While the majority of information circulating regarding healthcare integration is related to integrating behavioral health into a primary care setting, it’s a mistake to assume that primary care will absorb all behavioral health services. Specialty behavioral healthcare plays a distinct and important role within healthcare. Individuals with serious mental illnesses historically receive the majority of their services in community behavioral health settings. Many prefer to receive their primary care services within this setting as well for a variety of reasons. Primary care, in its typical current structure, would require significant modifications to take on the added line of business. Many organizations have successfully managed this, with Cherokee Health Systems leading the way for decades. However, primary care clinics that are not prepared nor inclined to follow this model may defer to the Behavioral Health Home.

What is a Behavioral Health Home?

First, let’s talk about what it is not. It is not a group home or nursing home. It is not a physical structure meant to house those in need of behavioral health services. The behavioral health home is a behavioral health organization that serves as a health home for people with mental health and substance use disorders.

Behavioral Health Homes for People with Mental Health and Substance Use Conditions prepared by Dr. Benjamin Druss and Dr. Laurie Alexander for the SAMHSA-HRSA Center for Integrated Health Solutions provides a thorough overview and guidance for establishing the behavioral health home. This document provides practical information for providers in their efforts to provide a more comprehensive delivery system to address the triple aim of healthcare. Behavioral Health Homes for People with Mental Health and Substance Use Conditions is an excellent resource and a must-read for providers in their efforts toward transitioning their organizations into a behavioral health home.

behavioral health integration · behavioral health primary care integration · healthcare integration

Integration of Behavioral Health and Primary Care: Preparing for Service Delivery

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When your behavioral health and primary care integration partnership has worked through the preliminary groundwork for integrating services (click here for more information on planning), it’s time for preparing for the delivery of the services. The detailed outline created in earlier steps becomes your business plan. The plan serves as a map of the partnership’s goals and provides direction for delivering services.

Formalizing the partnership

When two organizations are collaborating for providing integrated services, it’s important to understand the legal and regulatory requirements. Working through this process should include consultation with an attorney. The following resources provide additional information for consideration:

Service Delivery

Once the legalities have been addressed, including the signing of a Memorandum of Understanding, Business Associates Agreement, etc., it’s (finally!) time to establish a start date and prepare for the delivery of the much needed services. The preliminary work, though tedious at times, was necessary to ensure the success of service delivery.

Careful planning is the hallmark of successful healthcare integration!

Through the careful planning of the behavioral health and primary care providers, they are ready to offer services in a more holistic manner. With co-morbid behavioral and physical health conditions more often the rule rather than the exception, the newly integrated services enable the team to provide much more comprehensive care coordination in this behavioral health and primary care marriage than either partner could have done independently. The whole is greater than the sum of its parts!

Celebrating Success

Once the equipment and supplies are in place, staff training is completed, and the start date has been announced to internal and external referral sources, it’s time to celebrate!

Celebrating important milestones is very important for ongoing success. It is an opportunity to strengthen relations among the healthcare integration team. Also, celebrating milestones is a valuable opportunity for leaders to re-energize their employees around the partnership’s Strategic Objectives by thanking the people who helped make the achievements happen.

Though things won’t always be harmonious, the partnership can persevere the difficult times through establishing a strong core to build upon. As discussed in The Partnership: Creating a Solid Foundation for Successful Healthcare Integration: “A partnership that has the solid and flexible foundation that is necessary for a lasting partnership” will weather the inevitable storms ahead.

If we are together nothing is impossible. If we are divided all will fail.
–Winston Churchill

behavioral health primary care integration · healthcare integration

Integrating Behavioral Health and Primary Care Services: Checklist for Developing the Plan

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You have decided on the model that best meets the needs of your partnership and community (click here for Choosing the Right Model for Your Integrated Healthcare Services) and you’re ready to move forward to the next stage. The planning stage is preparation for implementing services and can be divided into three parts: clinical, financial, and operational.

This guide can serve as a checklist for partners to use in preparing for service delivery.

Clinical

The planning should include a detailed account of the service array to be provided, to include the following:

  • Identification of the targeted recipients of the services
  • Determine the specific services to be delivered and by whom
  • What clinical tools will be used?

Financial

Prepare a detailed account of the codes that are to be billed, including which partner will bill for each service. Other important topics include:

  • A determination of how labs and prescriptions will be processed. Typically, CHCs have access to better rates for each. Careful planning allows for maximizing billing opportunities.
  • Who will operate the patient assistance program? How will it be managed?

Operational

Entering into a partnership affects every aspect of the organization: clinical, support, administrative, IT, etc. Successfully navigating change cannot be accomplished without staff buy-in: they will be the ones primarily responsible for implementation. Therefore it is vital to involve employees from each of the organizations in the planning process.

Don’t forget that communication is a key element. Transparency is necessary from the onset. Identify champions from various levels within the organizations to assist with the detailed planning. Create implementation teams with staff from each organization for early face-to-face interaction.

Include the following in your planning:

  • The physical space: Careful thought must be put into this and MUST include both partners. It’s common for new projects to be housed in existing empty offices, frequently in out-of-the-way locations. This, however, is not the correct approach for healthcare integration. The physical space is extremely important and requires careful consideration in ensuring that the imbedded staff do not work in isolation but are able to interact with others frequently. Shared space allows the relationships to develop, fostering the sense of being a team. Frequent passing in the hallways allows for hallway consults, facilitation the collaborative approach.
  • Compliance: Regulatory requirements of JCAHO, CARF, etc. It is very important to understand and respect your partner’s requirements.
  • Liability insurance: Depending on the type of partnership, coverage will vary. It’s important to review requirements to ensure appropriate coverage.
  • Process mapping: This a vital component and must include input from clinical and administrative staff.
  • Workflow: Focusing on the experience of the patient/client is important for success.

Also, the following are very important to consider:

  • What clinical, financial, and operational outcomes are expected?
  • How will clinical, financial, and operational outcomes be tracked and measured?

It cannot be emphasized enough that this process cannot be successfully completed by a small group of executive staff. Successful change requires the involvement of all stakeholders.

behavioral health integration · behavioral health primary care integration · collaborative care · healthcare integration · primary care behavioral health integration

The Partnership: Choosing the Right Model for Your Integrated Healthcare Services

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Determining the Model

How do partnering Community Behavioral Health Centers (CBHC) and  Community Health Centers (CHC) determine the ideal model for their foray into integration? There are many factors to consider such as:

  • What are the needs of the individuals served by the partnering organizations?
  • What are the needs of the community?
  • What resources do the organizations bring to the partnership?

Now that the partners have a solid foundation and clear vision for their collaboration, it is time for the careful planning that is necessary to make it a reality.  There are effective tools available to assist organizations in working through this very important process. (Please note that these suggestions and resources are not limited to community providers.) 

The MH/Primary Care Integration Options scale  is available on the SAMHSA-HRSA Center for Integrated Health Solution website. This is very helpful for leading the discussion among the members of the implementation team. The scale assists the partners not only in determining the current reality but also mutually deciding on the desired level of integration: Minimal Collaboration, Basic Collaboration from a Distance, Basic Collaboration On-Site, Close Collaboration/Partly Integrated, and Fully Integrated/Merged in each of these key functional areas:

  1. Access: How do individuals access services?
  2. Services: Are the services separate and distinct or are the primary care and behavioral health services seamless? Or perhaps somewhere in between.
  3. Funding: Do the partners share resources or are they separate?
  4. Governance: Are there separate boards of directors for each organization?
  5. Evidence-based Practices: Do the organizations administer the PHQ-9 or disease registries, for example, and share the results?
  6. Data: Do the partners share information? Do the providers have access to the partner’s EHR?

This assessment process is most effective when stakeholders from each organization are included. Ideally, representatives are included from clinical, management, and administrative departments, as well as a few individuals who use the services. It’s very helpful to have frontline staff and board members to take part as well.  Call center and reception staff offer a unique perspective that leadership frequently finds enlightening.

Other useful tools available include the National Council’s Success in the New Healthcare Ecosystem: Mental Health & Substance Use Provider Readiness Assessment prepared by Dale Jarvis.   This allows provider organization management teams to assess their organization’s readiness for engaging in the changing healthcare system.

Another tool to consider is the COMPASS-PH/BH  created by Zia Partners.  This self-assessment tool is used for primary care/behavioral health integration for implementation of a Comprehensive Continuous Integrated System of Care.

Making the Vision into a Reality

Once the ideal model of integration has been determined, the journey begins to make it a reality. Be sure to stop by for the next installment in the series.

What tools or methods have you found to be helpful when selecting a model for your healthcare integration endeavor?

I would love to hear from you! Please email your suggestions to me at behavioralhealthintegration@gmail.com for inclusion in a future post.

 

behavioral health integration · healthcare integration · primary care behavioral health integration

The Partnership: Creating a Solid Foundation for Successful Healthcare Integration

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Consider this scenario:

The CEO of the local Community Behavioral Health Center (CBHC) and the CEO of the local Community Health Center (CHC) bump into each other at a local community function. The conversation turns to a deliberation about healthcare integration. They plan to meet for lunch next week to discuss it further.

At lunch, they examine the latest healthcare trend: providers from behavioral health and primary care joining forces to form integrated healthcare partnerships to improve health outcomes. Both agree that theirs’ is a match made in heaven. Over dessert they decide to become partners, sealed with a firm handshake.

What happens next?

For a successful partnership, it is crucial to start with a solid foundation that includes flexibility in the core structure to weather the inevitable storms ahead. This must be accomplished before beginning to build. Failure to adequately address this will result in a partnership that appears to be healthy on the outside but with a weak core. Remember that it’s easy to have a good relationship during the good times. When troubles arise, the solid core serves as an anchor to enable perseverance.  To accomplish this, there are key areas that must be discussed thoroughly before moving on to formalizing the partnership.

Why is this important?

Consider this version of the next chapter in the aforementioned scenario:

Over a series of phone calls, the two CEOs discuss the details of their lunchtime plan for partnering to to provide integrated healthcare. Topics discussed include creating a Memorandum of Understanding; financial arrangements (who pays for what); which services will be provided; and who bills for which services; becoming a health home. Separately, the CEOs meet with their management teams to plan logistics. At that point the leaders, thinking their work was done, withdrew from the planning. The management teams put together the clinical teams for providing the services. The various teams finally meet for a face-to-face planning session, roughly two weeks prior to the scheduled kickoff. The CEOs make a final appearance to give it their blessings.

The teams are thrust into the arranged marriage, virtual strangers. They never had the opportunity to establish a relationship before the partnership was finalized.

Shortly after the two year anniversary, the partnership is dissolved. The two CEOs think back to the dessert agreement with the “happily ever after” partnership they envisioned and, scratching their heads, wonder what happened.

Unfortunately too many partnerships follow the course outlined above. Once the relationship is dissolved, the organizations return to business as usual. However, it is the people who received the integrated services who are hurt as a result; once again left without services.

Some important things to consider for a successfully integrating behavioral health and primary care include the following:

Identifying the Vision and Mission

Locating a partner is an important first step. Before the partnership is formalized, however, it’s essential to carefully clarify the vision and mission to ensure that they are in alignment with the expectations of each of the organizations. Each partner must become very familiar with the other’s mission and vision. These questions will help to drive that discussion:

    • Are the potential partners prepared for taking on a new business venture?
    • Are the stated missions of the organizations in sync?
    • Can the long-term plans of each organization be adjusted to include this partnership?

Over the next few weeks we will examine critical steps to ensure that your partnership avoids the pitfalls that the organizations in the scenario encountered: A partnership that has the solid and flexible foundation that is necessary for a lasting partnership.

Next week we will take a look at the process of determining the level of integration that will best fit with your vision for the partnership.

Healthcare Integration Partnerships: Understanding Specialty Behavioral Health
behavioral health integration · healthcare integration · primary care behavioral health integration

Healthcare Integration Partnerships: Understanding Specialty Behavioral Health

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The integration of behavioral health and primary care services allows for a holistic approach for the treatment of people with serious behavioral health disorders. As the disparate healthcare providers join together to provide treatment, the obvious differences between them must be addressed for success.

There are misconceptions that behavioral health providers want to address with their primary care partners for maximizing their integration efforts.

Understanding the Community Behavioral Health Core Mission

Community Behavioral Health Centers (CBHCs) are specialty behavioral healthcare providers and serve a vital role in the healthcare industry.  The community behavioral health system provides treatment for individuals who have serious mental illnesses, substance use disorders, co-occurring SMI/SUD, and children and adolescents with serious emotional disturbances. These organizations are not a repository for the worried well. Their role is to address complex disorders that are generally beyond the scope of practice of primary care providers. In addition to providing psychiatric oversight, they also possess an expertise in rehabilitation and recovery that is not available in primary care. These services include psychosocial rehabilitation, peer support, case management, supported employment, and supportive housing. Treatment is provided through a team approach that begins with a thorough biopsychosocial assessment to identify life stressors, level of functioning, and clinical symptomology. Services are directed by the psychiatrist or psychiatric-extender who serves as prescriber.  Counseling, rehabilitation, recovery, and support services are carried out by other members of the team.  CBHCs can work collaboratively with CHCs to effectively meet the whole health needs of people with behavioral health concerns.

Differing Pace and Workflow 

The CBHC pace is very unlike that of the primary care clinic. Long waits for appointments are the norm rather than the exception. CBHC office visits with the prescriber frequently exceed the standard 15 minute allotment in the CHC. This is due to the complexity of symptoms of many of the individuals served. While some CBHCs are beginning to use an open access approach, most are still using the standard scheduled appointment model that may result in a several week wait to see a prescriber. This has been a barrier to working collaboratively in the past. CHCs have opted to avoid making referrals because of the excessive wait and lack of status updates.

A side note: behavioral health can assist with the flow in the primary care setting. The flow of busy primary care clinics can be side-railed by patients with behavioral health disorders in addition to their other health concerns. Adding a behavioral health specialist to the team to address the behavioral health issues improves the flow, patient satisfaction, and clinical outcomes.

Lack of Regulation Uniformity

Reimbursement for CBHC services varies greatly from primary care. Block grants for mental health and substance use disorder treatment are regulated at the state level, resulting in a lack of consistency. Each state has created its own system for determining how the funds are allocated and how outcomes are measured. The process of billing for and receiving reimbursement for services is tedious. Some states have opted for capitation; others have a fee for service system. Other states have outsourced this to managed care companies.  Historically private insurance has not provided equitable coverage for behavioral health disorders, creating a gap between coverage for behavioral health and physical health conditions. A mental health law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, ensures that individuals with mental health and substance use disorders receive healthcare services equal to those for physical health conditions without larger co-pays.

Unique Needs of Specialty Care

The National Association of State Mental Health Program Directors (NASMHPD) 2006, Morbidity and Mortality for People with Serious Mental Illness, reports that people with serious mental illness are dying on average 25 years earlier than the general population. In addition, according to Substance Use Disorders and the Person-Centered Healthcare Home a 2010 report by Barbara Mauer, people with co-occurring mental illness and substance use disorders were at greatest risk with their average age of death 45 years of age. The people we serve are dying prematurely in part due to poor quality of medical care. This population fails to get adequate healthcare for a variety of reasons. Integrating primary care services in the behavioral health setting is a viable solution for improving health outcomes.

  • Specialty behavioral health services for individuals who have a serious mental illness and one or more comorbid health condition requires coordinated care. Ideally the care is delivered via the behavioral health home. The team is led by the psychiatrist working closely with the entire treatment team, including the primary care provider.
  • Stigma is a barrier to accessing services for people with behavioral health disorders. Historically preconceived notions associated with behavioral health disorders have limited effective access to healthcare by many individuals.
  • Due to the pervasive lack of support systems for people with serious behavioral health conditions, the role of case manager is extremely important for supporting identified functional needs. Case managers frequently assist clients with preparing for visits with their primary care provider and often accompany them as well to ensure coordinated care.

Solution for Information Sharing

Historically CBHCs have not freely communicated with primary care about their shared patients. This originated because of a common misperception that has persisted in behavioral health that sharing mental health and substance use information with primary care providers is prohibited without going through an elaborate process. CBHCs realize that this has created a barrier for collaboration and are actively working at developing a solution; addressing HIPAA/confidentiality and 42 CFR Part 2 to develop a process for effectively sharing information.

It is through increased understanding of the differences between the healthcare partners that true success will occur, evidenced by improved health outcomes.

healthcare integration

Health Information Technology and Healthcare Integration

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Health information technology (HIT) is important to healthcare providers for a variety of reasons, not the least of which is for complying with Medicare and Medicaid Electronic Health Records (EHR) Incentive Program requirements.

HIT is critical to the success of health homes and healthcare integration, allowing behavioral health and primary care providers to share information. This sharing enables healthcare providers to have access to all available healthcare information related to the individual being served. And this, of course, results in improved health outcomes. The SAMHSA-HRSA Center for Integrated Health Solutions has a wide array of HIT resources: click here for more information.

The Past

Not too many years ago, healthcare providers were handwriting or dictating their progress notes. When patients were seen outside the office, or if the notes were not yet filed in the chart, the limited amount of information available created a challenge to providing the best care. A patient who was unable to provide a thorough medical history was being treated blindly in some regards. And health implications aside, numerous medical procedures were repeated due to lack of access to the reports. Duplication of the procedures drove up healthcare costs.

In addition, the sharing of information between providers was the exception rather than the rule. Coordination of care between providers for patients referred to specialty care was not reimbursed and, as a result of limited resources, less than ideal. This brief history lesson on medical records serves to illustrate the value of electronic health records and health information technology.

Fast Forward to the Present

Though far from ideal, the healthcare industry is making great strides in health information technology, including health information exchanges (HIEs) designed to facilitate the sharing of data. Despite the rapid progress, sharing information continues to be a challenge for behavioral health and primary care organizations. These integration efforts create unique challenges, largely due to problems with sharing information between two systems. The electronic health records (EHRs) used by primary care providers are seldom compatible with EHRs used by behavioral health providers. While some partnerships have implemented means of addressing this (work arounds), such as a third system to link the two or “home grown” alternatives, there are currently no ideal options available.

These noble community providers persevere however. They are well accustomed to dealing with challenges in the quest for pursuing their mission. People with serious mental illness are dying prematurely; and has been inadvertently perpetuated by this lack of information sharing. In an attempt to be respectful and responsible with healthcare information, limitations (and misunderstandings) have impeded information sharing. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191 and Title 42: Public Health Part 2—Confidentiality of Alcohol and Drug Abuse Patient Records, also known as 42-CFR Part 2, are the most frequently cited reasons for not sharing information. These federal regulations cite guidelines for confidential health information. Though intended to provide clarity, healthcare organizations have interpreted the regulations very conservatively.

The Future

HIT has changed the face of healthcare and holds great promise for the future of behavioral health and primary care integration. Health information technology is not only providing cost-effective means of providing superior collaborative treatment, it is paving  the way for reducing the health disparities for people with serious mental illness and other behavioral health conditions.

behavioral health integration · behavioral health primary care integration · healthcare integration

Yours, Mine, and Ours: Workforce and Healthcare Integration

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A company’s greatest asset is its workforce. The employees are the lifeblood of organizations, as I’m sure most leaders would agree. Therefore, paying close attention to keeping your employees informed and engaged when entering into an integrated behavioral health and primary care partnership is crucial for success. And the sooner, the better.

Sibling Rivalry

Like blended families, the integration of two organizations brings up some fundamental concerns among the employees. Concerns over job security, roles, and change in general are paramount. Your employees will be working with the employees from the partner company and will not likely develop into a cohesive team immediately. Additional challenges are introduced with the unique role of the employees who are hired jointly by the partners. The uncertainty and anxiety are sure to result in sibling rivalry among employees. Sibling rivalry is characterized by a jealousy that develops between employees, much the same as it does among siblings. This, of course, impedes teamwork, especially if some members of the team are granted a superior status. This  sometimes happens when the integration efforts are held out as being a special or top-priority project. While it’s not possible to eliminate all anxiety, it’s possible to avoid sibling rivalry among your, my, and our employees and to allow them to transition into a unified team.

Healthcare integration is in its infancy and trained workforce is sparse. However, it is not necessary to hire new employees for your enhanced services. Providing training for employees, ongoing thorough and consistent communication, coupled with reassurance on the front end will go a long way toward successful integration of the employees, and are key to success. The following guidelines will help to promote a close-knit and committed integrated team:

  • Communicate an overview of the vision of the partnership followed with frequent status updates. This also helps your team develop a sense of buy-in to the mission.
  • Provide each team member with a clear understanding of his or her role and how it fits into the whole.
  • Provide ample training for all team members to ensure that they are well prepared for healthcare integration.
  • Building trust among employees is vital for effective teamwork. Frequent opportunities for face-to-face interaction are important for developing a sense of camaraderie.
  • Champions within the organization play a large role in the success of projects. Recognize them (they are in all levels of the organization, just look for them) and allow them to take on leadership roles.
  • As with all new endeavors, solicit feedback from your team. By providing an environment that values candor, early missteps are quickly corrected and creative ideas are put to use for long-term success.
  • It’s important to recognize that some people belong on the bus but are just in the wrong seats. Keep an eye out for employees who are on board with the mission but struggling with their current role(s). These employees are keepers and should be placed in roles that emphasize their strengths.
  • And vital to a successful team, it’s important to acknowledge when an employee is neither prepared nor motivated for the adjustment in the mission and must seek professional fulfillment elsewhere.

What would you add to this list?

For successful healthcare integration, focused attention to your workforce can quickly transition “yours, mine, and ours” to an effective integrated team.

behavioral health integration · behavioral health primary care integration

For Better or for Worse: Honoring the Partnership in Behavioral Health and Primary Care Integration

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“I now pronounce you…Integrated.”

The early days of the integrated healthcare relationship are typically idyllic, filled with smiles and hopes and dreams. Oh, if we could only maintain that blissful state forever…

Unfortunately relationships don’t maintain a static pattern but are interspersed with disruptions on occasion (or frequently). When these disturbances intervene, the blissful state is challenged.

These are the times that try administrators’ souls.

For a partnership to persevere the inevitable challenges, the basic foundation must be solid.  Just as skyscrapers are built with deep foundations that are not only solid but allow flexibility to prevent collapse when severe environmental or other hazardous conditions erupt, the integrated partnership requires a carefully developed, yet flexible foundation. With a firm core, the relationship has the elements in place to withstand challenges that are sure to occur. (Click here for more information on building a successful behavioral health – primary care partnership.)

Sustainability Planning

Sustainability plans are often synonymous with financial sustainability but will occasionally focus on health information technology in the planning as well. The partnership itself, however, is often overlooked in the sustainability plan. This is unfortunate because if the partnership fails, the plan is rendered moot. The actual partnership itself is taken for granted after the initial honeymoon phase. This is a grave mistake for true sustainability.

Consider this scenario:
Due to internal operational and fiscal needs, the behavioral health partner’s executive team has decided to reassign the integrated BH counselor who has been working in the primary care clinic for two years. The counselor will be replaced with another counselor who is more experienced and is credentialed in both mental health and substance use disorders. Seeing this rearrangement as a win-win, the behavioral health partner is shocked and confused when they hear that the primary care partner, in reaction to this news, is considering hiring their own counselor instead of accepting the replacement counselor. There are even rumors that they might pull out of the partnership.

What went wrong?

  1. The behavioral health partner failed to include the primary care partner in the discussion, thus failing to honor the relationship; the primary care partner felt disrespected.
  2. Rather than express concern to the behavioral health partner, the primary care partner took a reactionary approach instead.
  3. Unaware of behavioral health partner’s internal issues, the primary care partner assumed the worst.
  4. The behavioral health partner failed to understand the value of the individual to the team, not just for the service provided. Counselors are not interchangeable. The counselor was viewed as a valued member of the primary care team.
  5. The executive teams of the partners stopped communicating after the partnership was launched, resulting in a weakening of the committment by each partner.

The list could go on.

This partnership, though financially sound, has neglected to nurture the core relationship. As long as things were going smoothly, the partnership appeared to be successful. Unfortunately, a slight disruption to the routine has threatened the weak core of the partnership. In addition to the obvious lack of effective communication taking place in this dysfunctional relationship, there are other factors also present that are all too common in partnerships:

  • Lack of commitment
  • Lack of respect

Commitment and respect underscore the core requirements for longevity.

Commitment

All partners must be committed to ensuring that integration efforts have the necessary tools for success. This includes the committment of time, not just financial and other resources. When the commitment is present, there is no concern over “fair weather friends” syndrome.

  • Are you prepared to make sacrifices necessary for success?
  • When the going gets tough are you still committed?

Respect

Basic respect is crucial. Your partner has many challenges and concerns that are unrelated to your partnership. Respecting that these are important to your partner whether or not you can fully recognize the impact goes a long way toward being a good partner. Taking the time to gain a better understanding is even better.

  • Do you have a thorough understanding of your partner’s business model?
  • Do you understand the challenges that your partner faces specific to the specialty such as regulatory, operational, clinical, etc.?

Why are these things important?

Understanding and honoring the things that are important to your partner organization strengthens the core of your relationship. Remember, the Golden Rule applies to behavioral health and primary care integration partnerships, too.

behavioral health integration · behavioral health primary care integration · primary care behavioral health integration

No Margin No Mission: Sustainability in Behavioral Health – Primary Care Integration

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Of the many challenges in integrating behavioral health and primary care services, the one that garners the most apprehension and concern is sustainability. It is also the most frequent reason for hesitation in moving forward. Healthcare is not set up to address this. Primary care and behavioral health have different billing codes with no easily decipherable means of venturing outside the confines to include payment for integrated services. The mere thought of the process required to begin to tear down the barriers separating the two worlds strikes fear in the hearts of the most courageous administrators.

Healthcare administrators are presented with conflicting demands and are struggling to reconcile the next step. They can:

  1. Ignore the ever increasing focus on healthcare integration and hope it is just another passing fad; or
  2. Place even more burden on the ever-shrinking budgets and hope for the best.

Let’s take a closer look at the options:

Ignoring healthcare integration seems like the easiest solution. Administrators can align themselves with like-minded peers creating a support group who reinforces the notion that it will all just fade away if they merely wait it out. This group gets considerable pleasure in observing the early adopters from a distance, filled with certainty that they are all making huge mistakes. They pat themselves on the back encouragingly as they watch their naïve peers make the occasional fumble, while attributing any successes to sheer (unsustainable) luck.

Over-burdening the current budget seems to be irresponsible. Behavioral health administrators have been faced with budget cuts in unprecedented amounts over the past few years. While they have either become masters at doing more with less or have chosen to leave the field entirely, taking on a new business-line during the increasing uncertainty of their organizations’ financial states seems to be overly risky and counterintuitive.

Yet the pressure is on.

Nationally, more and more behavioral health conferences are featuring healthcare integration tracks. The same is becoming true of primary care conferences and conventions as well. With more and more research and reports being released that provide the necessary data to support the need for integration, it’s becoming more and more difficult to write it off as a passing fad. The recent report from the SAMHSA-sponsored, National Survey on Drug Use and Health, Physical Health Conditions among Adults with Mental Illnesses provides further evidence supporting earlier reports demonstrating the need for integration.

The current model of providing behavioral healthcare may be on its way to becoming obsolete. Now is the time for behavioral healthcare administrators to begin the discussion of how to address the whole-health needs of the people they serve. Whether through collaborative partnership agreements, bi-directional integration, or full integration, this issue can no longer be ignored. There are many changes that can be implemented right away (focusing on billing codes and maximizing billing opportunities) while others will require advocating changes at the state and federal level. (Click here for helpful billing tools created by the SAMHSA-HRSA Center for Integrated Health Solutions.) Daunting though this may seem, the climate is right for these discussions with your state Medicaid and behavioral health offices. They are faced with the task of making the necessary changes to move into the new era of healthcare integration. Strategically, it’s far better to be a part of discussions on creating this new structure than to have it imposed on your organizations. The Georgia Association of Community Services Boards has partnered with the Carter Center to create a forum for change in Georgia via their Integrative Healthcare Learning Collaborative. Not only have they included the public behavioral health providers and their primary care partners, they also have representation from the Georgia Primary Care Association and area medical schools.  They recognize that in order to develop sustainable programs everyone must be at the table.

What are your strategies for sustaining healthcare integration?
I’d love to hear from you. Please enter your comments/suggestions/ideas below or email: behavioralhealthintegration@gmail.com.

Let’s not lose sight of the goal: we must work together to make a difference in improving health outcomes of the people we serve. We CAN ensure that the margin is there to continue the mission. Be a part of the solution!