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Beyond a Fad: How Integrated Care Can Swim to the Mainstream

Posted By Cassidy Smith, Thursday, April 21, 2011
Updated: Friday, June 10, 2011
The concept of "integrated care” seems to have joined the ranks of smartphones and iPads. Like those nifty devices, integrated care is innovative, effective and sought-after -- yet, not everyone can afford it.

In plain English, integrated care is a way of providing health care services that engages individuals and their caregivers in the full range of physical, psychological, social, preventive and therapeutic factors necessary for a healthy life. Within health circles, integrated care has become "all the rage” in Colorado. To illustrate the proliferation of integrated care, the Colorado Behavioral Healthcare Council mapped some of the numerous efforts underway to integrate physical health and behavioral health care services.

Supporting the delivery of integrated care has been a funding priority for the Colorado Health Foundation in recent years. Yet, while grantees rave about the positive impact integrated care services have on patient health and provider morale, they consistently report it is difficult to maintain these kind of services due to reimbursement limitations and the complex nature of billing health plans. National data tells a similar story. A 2010 article in Psychosomatic Medicine by Roger Kathol, MD, concluded that correcting disparate physical and behavioral health reimbursement practices is crucial for the survival of integrated care.

On April 8, the Colorado Health Foundation along with the Collaborative Family Healthcare Association, the Colorado Psychological Association and the Colorado Academy of Family Physicians convened a summit of nearly 100 Colorado primary care and behavioral health providers, health plan administrators, nonprofit leaders and policymakers to talk about the challenges associated with sustaining the delivery of integrated care services.

Here are some of the conclusions summit participants reached on how to make integrated care the expected standard of care for all Coloradans:

  1. Change culture of behavioral health -- Negative judgments of those with a mental health condition or substance-use disorder persist among the general public as well as health care and social service providers; despite knowing these conditions can be treated and prevented like any other health condition.
  2. Train providers to deliver integrated care -- Most physical and behavioral health providers have not been trained to work together in teams to provide integrated care services.
  3. Test new payment models – Current reimbursement practices hinder the ability of physical and behavioral health providers to work effectively as teams to deliver timely care to patients.
  4. Get support of the business community -- As employers, businesses are significant purchasers of health care services and can benefit the most from positive health outcomes and cost savings associated with integrated care.
  5. Encourage public to demand change – Many individuals have not had the opportunity to experience integrated care. Therefore, they do not know that it is the optimal way to deliver care.

The Colorado Health Foundation is partnering with the Collaborative Family Healthcare Association to take a closer look at the financial barriers impeding the delivery of integrated care services. Over the next year, Collaborative Family Healthcare Association will work with a broad group of Colorado stakeholders to summarize the financial barriers to integrated care delivery; identify potential policy fixes; and build a financial case for changing current reimbursement practices.

Hopefully, this new effort will help move integrated care from "the next cool thing” to the normal way of doing business.

Cassidy Smith is a public policy officer at the Colorado Health Foundation where she works with a broad group of stakeholders to advance public policies to improve access to quality, affordable health care services. Before joining the Foundation, she was special project coordinator in the Medicaid office at the Colorado Department of Health Care Policy and Financing. Cassidy earned her master's degree in Health Policy and Administration from the University of Illinois School of Public Health.

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Randall Reitz says...
Posted Saturday, June 25, 2011
Cassidy, in reading your post, the aspect that sticks out for me is your call to for consumers themselves to advocate for collaborative care. This seems to be an aspect of advocacy that has been almost entirely neglected. The case is almost always made through academic journals, conference presentations, and policy summits like the one sponsored by TCHF/CFHA. What would it look like for the consumers to be the lead voice? Would this be one patient and one doctor in one exam room at a time or would you see it coming from consumer organizations like NAMI? If we were to stick with a top-down approach, it would seem reasonable to at least include the consumer voice at all public events.
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