Talking about public health can be tricky, because so many of the terms we use sound like jargon. When public health professionals are talking to each other, that may not be a problem; but when we’re trying to explain our work to community members or professionals from other sectors, the words we use might be confusing. Because CHNA 20 is deeply committed to growing collaborative relationships with all members of our communities -- not just the public health experts -- we’ll be periodically sharing simple explanations of complicated-sounding jargon we use when we discuss our work. We hope this will help demystify some of the jargon and make our efforts more understandable and accessible to our communities.
Providing the best standard of health care for all patients isn’t an easy task. One of the factors that often frustrates both patients and care providers is a disjointed system -- one in which a primary care doctor handles some aspects of a person’s well-being, while another provider, such as a mental health professional, takes care of another aspect of that person’s wellness. Both providers may be offering the best care they can, but if they’re not able to work together in partnership, sharing records, knowledge of the patient and ideas for treatment plans, each may lack the complete picture. As a result, patients often find themselves in situations where advice and treatment from one provider conflict with the advice and treatment from another, or where they’re offered an incomplete treatment plan because everyone involved lacks some important piece of information. That’s where integrated care comes in.
What is integrated care?
Integrated care is a model of health care delivery that organizes and coordinates patient care in an effort to improve the patient’s experience. Integrated care models recognize that:
A person’s overall health includes physical, mental, emotional, behavioral and environmental components;
Behavioral disorders are frequently co-morbid with chronic medical conditions;
Environmental stressors such as unemployment or food insecurity can lead to physical, mental and behavioral health disorders;
In order to maintain a complete picture of all these coexisting factors, patient care needs to be streamlined and organized so that it’s easier for patients to access services, and easier for those service providers to communicate and coordinate care.
What goes into designing a successful integrated care model?
To accomplish the goal of providing better coordinated care for patients, the integrated care model combines primary health care with behavioral health care, using a team-based, whole-person approach. The key components of an integrated care model include:
Case finding, screening and referral to care, including tracking and follow-up
Multidisciplinary care teams, which include patients as active participants in their own care
Ongoing care management that includes communication, coordination and assessment by the team
Systematic quality improvement to evaluate and implement improvements to the integrated care program over time
Decision support for measurement-based, stepped care, including evidence-based best practices, treatment protocols and access to appropriate behavioral health services to complement physical treatment
Culturally adapted self-management approaches that support patients in taking an active role in their treatment and well-being
Information tracking and exchange among providers, using systems that help streamline provider communication
Linkages with social and community services such as housing, social services, nutritional assistance and other supports to address environmental concerns impacting patient well-being
Are there any barriers to implementing integrated care in every community?
While there is evidence that effectively designed integrated care models improve the quality of patient care and outcomes while also reducing costs throughout the system, it’s not quick or easy to make the shift from traditional care delivery to integrated care. There are both external and internal barriers that might deter communities and health care facilities from adopting an integrated care model.
External barriers are generally regulatory and policy-based. They might include privacy laws that inhibit certain types of information sharing, or state regulations that govern behavioral health practices. Infrastructure issues might also play a part, if health information technologies can’t support regional exchanges of information or sharing of community needs assessments. There can also be challenges with both financial and human resources. If reimbursement structures or grant funded mechanisms within the system don’t allow for sustainable financing of different care programs, integrated care models will suffer. Likewise, it’s impractical to set up integrated care in a region that lacks enough sufficiently trained behavioral health providers to partner with primary care physicians.
Internal barriers exist within the teams and organizations required to facilitate integrated care. Establishing teams might be a challenge in some areas, especially if primary care physicians are reluctant to buy into a new model. Workplace culture and approach to care might also differ between primary care and behavioral health care teams, making it difficult to implement good teamwork and effective processes as a unit. There are also workflow, billing, physical space and scheduling considerations that can present significant challenges as two or more separate offices seek to merge their practice.
You can read more about various integrated care practices and the impact of public health developments like the Affordable Care Act and COVID-19 on integrated care here: How Practices Can Advance the Implementation of Integrated Care in the COVID-19 Era
Are there any examples of integrated care in the Blue Hills region?
One example we can share is the integrated care model implemented by Manet Community Health Center in 2017. Manet developed a behavioral health pilot program in its Quincy and Hull locations, placing credential substance abuse and mental health clinicians inside primary care sites to provide a more seamless patient experience. The clinicians installed by Manet form an in-house behavioral health care team that can work in tandem with the on-site primary care providers, using a collaborative treatment plan that accounts for shared health records. Through this care delivery model, Manet’s patients are able to receive better services for their substance use disorder and behavioral health needs while also attending to their primary care needs.
Another regional example of integrated care is the Grayken Center for Treatment, a care delivery system set up in 2018 by South Shore Health. Based at South Shore Medical Center in Norwell, the Grayken Center offers office-based addiction treatment within the primary care setting. This model ensures that patients who present with substance use disorders are able to access appropriate care for those needs within the same office as their primary healthcare, and that their addiction treatment can be coordinated with their primary care needs, treating the patient as a whole person whose wellness is impacted by interrelated factors.
Integrated care is an important development in the ongoing quest to improve public health in the Blue Hills and beyond. In our capacity as a convening and connecting hub for improved community health, CHNA 20 will continue to do all that we can to help support our member organizations and partners across the region in overcoming the barriers to integrated care, allowing for better care delivery to all Blue Hills residents.