Opinion: Integrated care — from ideas to execution

By Sharon Adams

Colorado recently submitted a revised State Health Innovation Plan to the federal government. It’s an enhancement of the original plan submitted in 2012. The Innovation Center at the Centers for Medicare and Medicaid Services is providing grant money to states with fully developed, promising plans aimed at improving health and lowering costs. The next step is for Colorado health leaders to submit proposals by next month so we can fund our plan and put it into action.

So what’s in the plan exactly? It’s hard to sum up 217 pages, but in a nutshell, the plan hinges upon first developing integrated behavioral and physical health care systems rooted in primary care medical homes. To do this, we’ll need to adapt the way we deliver care so we identify and address mental and behavioral health issues at the same time we’re seeing people for an annual exam or common cold. Since our current reimbursement structure doesn’t support this model, we’ll need to simultaneously change how we pay for care so that clinics serving as medical homes can afford this integrated approach.

The reality is that many Community Safety Net Clinics (CSNCs) are already working towards integrating behavioral health because they understand the value it brings to their patients. A few, like Marillac Clinic in Grand Junction, have been modeling this for years.

About one in four visits at Marillac are team-based meaning that both a primary care provider and a behavioral health provider see the patient simultaneously, addressing the whole person at once. Marillac has found that moving to this truly integrated model of care, rather than merely co-locating behavioral health providers in the same facility, makes each visit more effective and efficient for providers. More importantly, patients benefit immensely because underlying issues are addressed that may be manifesting in acute illnesses or exacerbating chronic disease conditions.

Marillac doesn’t get paid to provide behavioral health services but they have made it a care delivery priority. They provide behavioral health services through their general operating funds — a combination of Medicaid reimbursements, patient sliding fee payments, grants, donations and in-kind support. And while it hasn’t always been easy, they have been fortunate enough to be able to find good behavioral health providers who are a fit for their team. Many other clinics have a difficult time just finding behavioral health specialists, and an even harder time finding licensed and credentialed providers reimbursable under Medicaid. That coupled with the fact that many CSNCs need Spanish-speaking behavioral health providers makes it even more challenging.

Because of these current payment barriers and provider shortages, Colorado has yet to see widespread integration of physical and behavioral health services. Simply beginning to pay for integration won’t cover the significant up-front costs and challenges of hiring staff in order to change the way clinics do business. Providing important behavioral health assessments and services when needed will require, among other things, updating Electronic Health Records, hiring and training staff and modifying patient flow.

Despite the challenges of implementing our SIM plan, the potential rewards for patients, families and our health care system are exciting. Many stakeholders, including ClinicNET and representatives from a wide variety of health care provider groups and communities were involved in informing and developing Colorado’s plan. I’m hopeful that these same thought leaders combined with the determination of CSNCs and providers statewide to deliver integrated physical and behavioral healthcare in a medical home will anticipate and overcome inherent challenges and put this plan into action for the improved health and wellbeing of all Coloradans.  www.coloradosim.org

Sharon Adams is the Executive Director of ClinicNET, which works to ensure that Colorado’s vulnerable populations get affordable, high-quality care from safety net clinics.

Opinions expressed in Health News Colorado represent the views of the individual authors.

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