There is great interest in integrated service delivery models – loosely defined as the delivery of primary care and behavioral health services in a collaborative fashion. These “integrated services” are preferred by payers because of the potential to decrease costs through better coordination, and preferred by consumers for convenience. The question for service delivery organizations – how to make these services financially sustainable?
Financial sustainability is no small issue. Physicians are leaving primary care practice in record numbers and a great number of “integrated” service delivery models are funded by grants or safety net funding – and lack the legs for sustainability in the world of typical health plan reimbursement.
To plan for the sustainability of integrated service delivery, the starting point is the model. There are five options for specialist organizations thinking about how best to add integrated service models to their portfolio – the options are outlined in the chart below.
|Specialist Organization Business Model Options For Participating in Integrated Service Delivery|
|1. Specialist organization adds primary care capacity|
|2. Specialist organization co-locates services in primary care organization|
|3. Specialist organization merges with primary care organization|
|4. Primary care organizations provides behavioral health services using specialist web-based and telehealth services|
|5. Care coordination through shared consumer data|
Many specialist organizations are hiring primary care professionals to add primary care capacity to their service array. This arrangement has the advantage of control, but it also has the disadvantages of high risk and high cost. To avoid those risks, many specialist organizations are creating partnerships that allow them to provide integrated services by co-location of services with primary care organization. This means less risk, but includes greater difficulties (financial, operational, cultural) in making collaboration work. The final option is to move beyond collaborative co-location models to creating integrated service delivery through the actual merger of primary care and specialist organizations.
The other two options for delivering integrated services are made possible through technology. One option is to “integrate” by providing specialist services in primary care setting by virtue of telehealth and virtual “on demand” services. The last of these options is virtual integration through care coordination, facilitated by information sharing.
When planning your organization’s integrated service delivery strategy, it is important to remember that what matters to payers are models that reduce total consumer costs. For more on planning integrated service delivery models, check out these resources:
Telehealth On The Rise all members
Six Challenges To Primary Care Integration all members
There are many options to explore – be sure to join OPEN MINDS Senior Associate ellise hayden when she teams up with Michael Mabanglo, LCSW, Ph.D., Director of Behavioral Health, Mendocino Community Health Clinic, Inc., for their presentation at the OPEN MINDS Planning & Innovation Institute – Integrated Care In Practice: How Primary Care Practices & FQHCs Are Providing Mental Health Services.
For another free resource, see What’s In A Word? A Lot, If That Word Is “Integrated” all members