Greetings from sunny San Diego! Today we launched the 2015 OPEN MINDS California Management Best Practices Institute with a pre-institute workshop Succeeding In A World Of Integrated Care: Options For Behavioral Health Provider Organizations, on integration, led by my colleague, OPEN MINDS Senior Associate George Braunstein.
Integration is one of those buzzwords that everyone is talking about – but the meaning of the term can vary significantly. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) defines integration as “whole person care that focuses on overall health; creates partnerships across all aspects of health; and is facilitated by a variety of clinical, structural, and financial arrangements and community supports that remove barriers between physical and behavioral health care” (Healthcare Integration In the Era of the Affordable Care Act). That definition is so broad that it lacks meaning (see What’s In A Word? A Lot, If That Word Is “Integrated”).
What we find when we analyze the health and human service market is that there are two types of integration going on – integrated care coordination and integrated service delivery. Each focuses on “integration” at a different level within the system.
Integrated care coordination is focused on the management and financing of care. Integrated care coordination entities include accountable care organizations (ACOs), medical homes, health homes, and disease management programs.
A great example of integrated care coordination is the health home model. In the Missouri Medicaid health home model, the state Medicaid system contracts directly with community mental health centers who serve as the health homes for a designated group of consumers. The state pays these health home organizations a per member per month (PMPM) fee to manage care, coordinate services, and provide referrals to community and social support services (see Medicaid Health Home Implementation In Missouri: A Year Later).
Integrated service delivery is about the model for delivering actual clinical care for consumers – not the management of care. In many jurisdictions, integrated service delivery is focused on delivering physical and behavioral health services in a coordinated fashion – at the same location, via telehealth, or through professional collaboration.
One example of integrated service delivery in action is the model developed by Tennessee-based Cherokee Health Systems. Cherokee provides integration by embedding a behavioral health consultant on the primary care team who provides real-time behavioral and psychiatric consultation for consumers during their primary care visit (see What Makes Integrated Care Work? Perspectives From Organizations With A Successful Track Record).
Understanding the distinction between these models is critical. Each represents a different provider organization role in the delivery system. Each of these models requires a different set of core competencies for specialist organizations.
For integrated care coordination, provider organizations need to think about having the management competencies to accept value-based payments, the ability to do clinical treatment planning and utilization management, the ability to share data across systems electronically, etc. For integrated service delivery, organizations need to focus more on an inward direction – thinking about clinical practice skills, communication between physical and behavioral health professionals, billing for concurrent services, etc. (see Making Integrated Service Delivery A Financial Possibility). As one of our attendees at today’s workshop said, “You can’t even start to think about how you can integrate until you understand the difference.”
Tomorrow we’ll continue our live coverage from California as we discuss the policy and financing issues that are shaping the California market – and the implications of these changes for the rest of the country (see California As A Bellwether). You can follow all the action live on Twitter @openmindscircle, with the hashtag #OMCalifornia.