Overview of Integrated Care Sheila A. Schuster, Ph.D.Advocacy Action Network

What is Integrated Care?  Basic notion is “No wrong door” for care  Individuals can access the health care system through any portal and find appropriate care for their physical and behavioral health care needs

What is Integrated Care? Focuses on the “whole person” Is seamless and coordinated care Includes a continuum of services Is multi-level care addressing physical and behavioral health needs INTEGRATED CARE

What is Integrated Care? INTEGRATED CARE Preventive Services Team of Health Care Providers Therapeutic Services

Why Integrated Care?  Primary Care Providers often do not know what to do with individuals who have significant behavioral health issues.  Primary Care Providers often do not want to see individuals with significant mental health issues in their offices/clinics.

Why Integrated Care?  Behavioral Health Providers often do not know how to recognize and identify physical health issues.  Behavioral Health Providers often do not want to see individuals with significant physical health issues in their offices/clinics.

Why Integrated Care? 60% of the office visits to Primary Care Providers are for symptoms that are psychological – and not organic – in origin.

Why Integrated Care? 80% of the psychiatric medications that are prescribed are written by Primary Care Providers.

Why Integrated Care?  Individuals with Severe Mental Illness (SMI) die 25 years earlier than their peers without SMI – due primarily to lack of treatment for preventable and treatable physical health conditions

Why Integrated Care?  Stigma around behavioral health is alive and well – and results in a very low percentage of individuals with behavioral health issues seeking treatment for those conditions

Why Integrated Care?  It is less stigmatizing to be seen entering a “Health Clinic” than a “Community Mental Health Center”... particularly in small town, rural Kentucky

What does Integrated Care look like:  There are many levels and models of Integrated Care, depending on the availability of providers, funding sources, context and history, statutory and regulatory supports or barriers, stage of development, and other factors

What does Integrated Care look like? Information Model:  Regular sharing of information about the individual between the Physical Health Provider and the Behavioral Health Provider Physical Health Provider Mental Health Provider

What does Integrated Care look like? Coordination Model: In addition to sharing of information between and among the individual’s providers, there is a shared referral network and coordination of screening and testing with sharing of results

What does Integrated Care look like? Co-Location Model:  Behavioral Health providers are located in medical facilities and/or Physical Health providers are located in behavioral health facilities, such as the Community Mental Health Centers  Supports increased sharing of information and consultation among providers

What does Integrated Care look like? Integration Model:  Individual’s physical and behavioral health needs are addressed in a combined treatment plan, developed and delivered by a multi-disciplinary team which may or may not be housed at the same location

ACA gives us the opportunity to address two different issues/populations:  Individuals with a primary physical health problem which has behavioral health sequellae – particularly depression (for which the individual may be self-medicating with alcohol or drugs).

ACA gives us the opportunity to address two different issues/populations:  Individuals with a primary behavioral health problem who also have significant physical health problems that go untreated or are partially or sporadically treated.

What We Need!  Advocacy for true Integrated Care generated and sustained by both the Physical Health and the Behavioral Health communities of consumers, families, advocates and providers

What We Need!  Advocacy for appropriate levels of funding. We know that Behavioral Health treatment works and recovery is possible...but only when treatment is available. And it is only available when it is funded!

What We Need!  On the public side, active working partnerships between the public health sector (Public Health Departments, Primary Care and Rural Health Clinics, FQHCs) and the behavioral health sector (Community Mental Health Centers, recovery centers, hospitals)

What We Need!  Accountability – ongoing evaluation and measurement of: best practices, quality, cost and cost savings/offset, patient and family satisfaction, population health indicators.

What We Need!  Providers on both the Physical Health side and the Behavioral Health side who are educated about integrated care, understand their role in achieving it, and are invested in making it happen

What We Need!  Education of consumers, family members, providers – both physical health and behavioral health, advocates, policy-makers and the public about behavioral health, recovery and integrated care.

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Tearing down the silos, thus reducing fragmentation and duplication of services… and keeping individuals from falling through the cracks

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Creating and utilizing transparent health information exchanges (like KHIE) that contribute in a meaningful way to integrated care for the individual

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Removing the barriers that currently block the delivery of integrated care, and creating incentives for collaboration/ integration.

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Making the case to policy-makers, payers and the public that it is more costly NOT to address co-occurring behavioral health issues of physical health conditions than to treat them

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Making the case to policy-makers, payers and the public that it costs much more NOT to do Integrated Care than to develop and sustain it!

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Paying for what you are measuring, not for numbers of visits  Paying for outcomes  Incentivizing collaboration

How do we get there? Policy-makers, Payers, Providers and Advocates Committed to:  Creating a path for sustaining integrated systems of care, noting that they will need to be continually revised, updated and improved!

For additional information, contact: Sheila A. Schuster, Ph.D. Licensed Psychologist Advocacy Action Network