Integrated Care Models
A wealth of evidence, examples, and models exist supporting and illustrating primary and behavioral healthcare integration as a means for delivering quality care and improving overall health outcomes. CIHS promotes the best information, tools, and models for provider organizations to draw upon as they design and implement integrated service in their practices and communities — whether it involves integrating behavioral health into primary care or primary care into behavioral health, or developing and working within a health home.
The Value of Integrated Behavioral Health: One of the first steps in building buy-in for integrated care is communicating the value of behavioral health integration (BHI) to key stakeholders including providers, clinical teams, administrators, leadership, public health officials, payers and others. Establishing or making the case for integrated care will help provider organizations pave the way for success. This resource will provide organizations with baseline information to help build and strengthen buy-in and to engage key stakeholders. Organizations may use this resource to:
- Customize the slide deck using their branded slides to fit the needs of the organization. Consider where your organization is at on its path toward integration;
- Mix, match and edit as appropriate to tailor to audience needs using data from your organization and community; and,
- Customize the message depending on your audience. It may look one way if you are presenting to payers and another if you are presenting to legislators.
As you plan for your presentation, contact the SAMHSA-HRSA Center for Integrated Health Solutions for help with your messaging. Just email: Integration@thenationalcouncil.org
Evolving Models of Behavioral Health Integration, a report from the Milbank Memorial Fund, reviews the collaborative care management approach to treatment that appears to improve the health outcomes for people with mental and medical disorders.It also identifies resources to assist policymakers and health care planners in selecting, implementing, and sustaining models of behavioral health integration.
A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites identifies the key professional practices that are prominent among exemplary integrated primary care organizations, with the aim of helping other sites achieve the goal of integrating care more effectively. Findings are organized into two categories: Organization-Level Professional Practices, and Interpersonal and Individual Professional Practices.
State Options for Integrating Physical and Behavioral Health Care, an Integrated Care Resource Center brief, discusses existing and emerging options used or considered by states for integrating the management and financing of physical and behavioral health services, with a focus on individuals with serious behavioral health needs. The four integration models described offer alternatives with various lead organizations serving as the core integrated care entity, including (1) managed care organizations (MCOs); (2) primary care case management programs; (3) behavioral health organizations (BHOs); and (4) MCO/PCCM and BHO partnerships as facilitated by financial alignment.
State Options for Integrating Physical and Behavioral Health Care, a new analysis from CMS’ Integrated Care Resource Center (CHCS), explores promising options for integrating general and behavioral health services within coordinated delivery systems, including examples of current state programs and critical considerations for implementation. It details four models for integration, including: (1) managed care organizations (MCOs); (2) primary care case management programs (PCCMs); (3) behavioral health organizations (BHOs); and (4) MCO/PCCM and BHO partnerships.
The National Council’s widely used Four Quadrant Model represents a population-based planning framework for the clinical integration of health and behavioral health services. The revised model incorporates the concept of the person-centered healthcare home.
The Doherty, McDaniel, Baird, Reynolds Levels of Integration model describes degree of involvement and sophistication in collaborative healthcare involving behavioral health and primary care. This useful tool enables healthcare organizations to determine their current and/or desired level of integration.
The Milbank Memorial Fund’s Evolving Models of Behavioral Health Integration in Primary Carethoroughly assesses models in their applicability to primary care settings, as well as the various challenges and barriers to integration.
AHRQ’s Integration of Mental Health/Substance Abuse and Primary Care reviews integrated care and how it may affect clinical outcomes. The report also specifies the conditions under which various integrated care models will work in ‘real-world’ settings, expands beyond prior reviews’ scope to include multiple illnesses and patient populations, and includes case studies to illustrate implementation of integrated care models.
The Integrated Behavioral Health Project’s Partners in Health: Primary Care/County Mental Health Collaboration Toolkit helps primary care clinics and government mental health agencies forge collaborative relationships. Though focused on California counties, much of the 180-page toolkit is applicable to other locales.
The MacArthur Foundation Initiative on Depression and Primary Care at Dartmouth and Duke has created a Depression Tool Kit, which is intended to help primary care clinicians recognize and manage depression.
Developed by Jurgen Unutzer at the University of Washington. The IMPACT model of depression care is one of the most widely implemented programs for treating depression in primary care. The IMPACT Model of Depression Care website includes online training and clinical toolkits for implementing the model.
The Chronic Care Model was developed by Ed Wagner, MD, MPH, Director of the MacColl Institute for Healthcare Innovation, and colleagues of the Improving Chronic Illness Care program with support from The Robert Wood Johnson Foundation.
A adaptation of Standford's Chronic Disease Self-Management Program for mental health consumers. HARP is a peer-led, manualized program designed to improve individuals' self-management of chronic illnesses.
A Cherokee Health Systems video illustrates a real-life integrated setting, and articulates the importance of advancing the integration of primary care and mental health.