Co-morbid medical and behavioral health issues are a significant burden, driving poor outcomes and high costs in US health care system per published and unpublished organization level and payer level data. As a recognized Patient-Centered Medical Home (PCMH), integration of behavioral health and ambulatory care (both in our primary care and high risk specialty clinics) is one of our current critical area of focus for the success and sustainability of our organization.
Based on the recent needs assessment (medical, behavioral and social needs) of our patient population and analysis of our 2015 and 2016 data from electronic health records for percentage of our patients with current behavioral health diagnosis, we have identified increased demand and necessity to optimize the level of behavioral health and primary care integration in all our locations (We currently have a co-located model in few of our clinic locations facilitating warm hand-off to support our patients behavioral health and medical needs).
In our integration enhancement analysis, we have identified several barriers:
- Financial barriers:
- Substantial need for the initial investment to redesign the care team, hire and or retrain staff. These initial investments would not be reimbursed by the payers. One option for us is to be prepared to operate at a loss in this initial stage of integration enhancement given our commitment to providing high-quality care to our patients and community.
- While we understand very well that integration in our PCMH will eventually lead to cost savings, one additional problem we foresee is that the savings most likely would accrue to different parts of the health care system (payer or hospital) than where the expenditure is needed (primary care).
- Clinical and operational barriers:
- Given the large size of our organization with several satellite clinics located independently or in our Housing service areas, standardizing and operationalizing the core components of integration into clinical workflows would be an interesting challenge with several issues including but not limited to staff engagement, divided middle management, merging two distinctly different cultures (behavioral health and primary care) and modifying EMR.
One of the strong points we have currently in support of this project is all of us in the executive team are committed to this practice transformation, which means we will present from our leadership team a shared vision of enhanced integrated care to all staff.