Why Should I Consider a Partner When Developing Integrated Services? Presented by: Kathleen Reynolds, LMSW, ACSW

Health Homes of the Future Funding starting to open up for embedding primary medical care into CBHOs, a critical component of meeting the needs of adults with serious mental illness

Go it Alone Pros  One governing board  One executive team  One treatment plan  Negotiate with yourself Cons  Need to learn a whole new business  Consumer may want to keep their existing primary care providers  Need additional accreditation  Need new Medicare/Medicaid numbers  Takes longer

Continuum of Integration Co-LocatedIntegrated Key Element: CommunicationKey Element: Physical ProximityKey Element: Practice Change Level 1 Minimal Collaboration Level 2 Basic Collaboration at a Distance Level 3 Basic Collaboration On-Site Level 4 Close Collaboration On-Site with Some System Integration Level 5 Close Collaboration Approaching an Integrated Practice Level 6 Full Collaboration in a Transformed/ Merged Integrated Practice Behavioral health, primary care and other healthcare providers work: In separate facilities, where they: In separate facilities, where they: In same facility not necessarily same offices, where they: In same space within the same facility, where they: In same space within the same facility (some shared space), where they: In same space within the same facility, sharing all practice space, where they:

 Have separate systems  Communicate about cases only rarely and under compelling circumstances  Communicate, driven by provider need  May never meet in person  Have limited understanding of each other’s roles  Have separate systems  Communicate periodically about shared patients  Communicate, driven by specific patient issues  May meet as part of larger community  Appreciate each other’s roles as resources  Have separate systems  Communicate regularly about shared patients, by phone or  Collaborate, driven by need for each other’s services and more reliable referral  Meet occasional ly to discuss cases due to close proximity  Feel part of a larger yet ill- defined team  Share some systems, like scheduling or medical records  Communicate in person as needed  Collaborate, driven by need for consultation and coordinated plans for difficult patients  Have regular face- to-face interactions about some patients  Have a basic understanding of roles and culture  Actively seek system solutions together or develop work- a- rounds  Communicate frequently in person  Collaborate, driven by desire to be a member of the care team  Have regular team meetings to discuss overall patient care and specific patient issues  Have an in-depth understanding of roles and culture  Have resolved most or all system issues, functioning as one integrated system  Communicate consistently at the system, team and individual levels  Collaborate, driven by shared concept of team care  Have formal and informal meetings to support integrated model of care  Have roles and cultures that blur or blend

Partnerships Pros  Requires collaboration  Can start quicker  Respects the history and competence of existing system  Financial benefits if public partner (FQHC, CHC)  Access to full continuum of care Cons  Requires collaboration  Can be time consuming  Organizational Culture work must be done  Confidentiality  Partner may not want to partner

Partnership Options With a CMHC and/or Addictions Agency With hospital systems With private for profit health clinics With managed care organizations Bi-directionality is key to successful agency partnerships

With CMHCs: The Business Case  Expertise  Payment for Care Coordination  Access to Care for More Severely Disabled  Improve UDS Elements

Selecting a Partner

What do we mean by “partner”?  A “partner” is a collaborator in service provision that works in another domain from the one you work in. A primary care clinic may partner with a behavioral health organization, or vice versa. Programs within the same organization may partner with each other, as well. A behavioral health organization may establish a health clinic at one of its sites. At the more advanced level, providers may partner in large collaboratives or networks to meet broader system or community needs.

Advanced Integrated Partnerships  A network of community health partners may collaborate with other organizations to address a range of needs in a single community. For example, a network of community- based organizations providing health and/or behavioral health services may partner with one or more hospitals.  Many communities have formed networks to partner with emerging Accountable Care Organizations, Regional Health Partnerships, and other emerging funding and coordination structures that may manage health and behavioral healthcare for large populations.

Partnership Checklist  Within the full array of primary health/behavioral health services (e.g., types of services, levels of care), identify and list the services that your organization already provides and the services that are needed but not provided or provided only to a limited degree (e.g., a large behavioral health organization provides a range of mental health and substance abuse services, but would like to include primary care services for clients without a primary care doctor).  For the services on both lists, identify all potential community provider partners that offer those services.  Prioritize potential partners who share your agency’s mission, vision, and values, including those that focus on helping the neediest members of your community.  If you do not recognize an obvious partner, identify where your clients currently receive those services. In a community with no FQHC or community health clinic, ask your mental health center or substance abuse treatment clients where they receive primary care, or vice versa. Those providers identified, even if they are

Partnership Checklist  Before approaching any potential partner, consider the following:  Is my organization proving services that our potential partner might perceive as a competitive threat? If so, are we prepared to be a supportive partner rather than a competitor?  What is my organization prepared to offer a potential partner? What is my organization’s business case? If you approach a partner by asking what they can do for you, it is likely you will be put off. Instead, think about what they may need and express willingness to help them, even if it is initially unclear how your help may be reciprocated.

Partnership Checklist  Does your organization have:  Timely and cost effective access to collaborative treatment, including curb side consultation?  Efficient service capacity — providing high quality services at the lowest possible cost?  Electronic health record capacity to connect with other providers and electronically transmit important clinical data?  Ability to focus on episodic care needs and treat to target models?  Ability and willingness to participate in bundled/shared risk payment models?  Outcomes that demonstrate that the organization can:  Engage clients in natural support networks  Help clients self-manage their whole health, wellness, and recovery  Reduce the need for emergency/high cost services for complex populations

Resources    Health Behavior Change: A Guide for Practitioners by Pip Mason and Christopher C. Butler.