The Path To Integration Depends On Where You Sit | OPEN MINDS – OPEN MINDS

Integration is a loaded word in the health and human service field.And the implications are dependent on where you sit.For payers and health plans, integration means a whole person approach to care coordination.The ideal model hasmedical, behavioral, and social needs addressed together in a system that has seamless consumer services, integrateddata at the consumer level, and alignmentof financial incentives.From the provider organization perspective, the question is to determine, even if your organization cant be the entire solution, how to create (through new capability development, mergers, or collaboration) a system with these characteristics.

These perspectives on integration were the focus of our session, Best Practice Models For Collaborative Care: Coordination Between Health Plans & Provider Organizationsat our 2020OPEN MINDS Management Best Practices Institute. The session had the perspective of both a health plan executiveMargaret Kisliuk, behavioral health administrator at Partnership Health Plan of California (PHC), and two provider organization executivesJim Coffee, chief operating officer and deputy director at Cowlitz Family Health Center; and Susan Foster, chief medical officer at Hill Country Health and Wellness Center.

Ms. Kisliuk said that PHC has been encouraging provider organizations to move to a more integrated model for behavioral health services since shortly after its inception in 1994. The health plan contracts with the state to administer Medi-Cal benefits through local provider organizations to 560,000 consumers, in partnership with 14 Northern California counties. They promote integrated care for outpatient substance use services through provider incentives and grant fundingincluding an intensive outpatient case management (IOPCM) model, which offers wraparound services for complex consumers with co-occurring medical and behavioral health conditions; promotion of telehealth for co-located behavioral health and other services; and training and education support.

While PHC primarily offers fee-for-service payment models, theyve introduced a few value-based quality improvement programs, including the IOPCM program and incentive payments for a range of activities. The activities include screening and brief intervention for substance use and provision of medication assisted treatment for addiction disorders. PHC has also brought in a telehealth provider organization, Bright Heart Health, with considerable behavioral health expertise to help primary care, emergency room, and other provider organizations identify behavioral health issues they dont have the expertise to manage on their own and virtually integrate the setting. PHC has seen that integration improves overall care for consumers, enhances the quality of life in the community (e.g., lower recidivism), and reduces coststhrough fewer emergency room visits and hospitalizationsby an estimated 30% to 40%.

For provider organizations (whether on the primary care or behavioral health side), moving to integrated care is animperativeboth for better consumer care and toaddress the changing preferences of health plans.But executive teams considering this path must be prepared to work with multiple (and at times conflicting) regulatory and payer requirements, lead their organizations through a significant culture change, invest in an adequate technology infrastructure, and focus on managing to metrics.

The all services at any door approach at Hill Country

Ms. Foster spoke to the Hill Country approach. All servicesmedical, behavioral health, dental, and chiropracticare offered in all three locations. Hill Country is Federally Qualified Health Center (FQHC) and a level three patient-centered medical home designated by the National Committee for Quality Assurance. They accept consumers with MediCal, Medicare, County Medical Services Program, and Child Health and Disability Prevention Program coverage, as well as most private insurance plans and offer a sliding fee scale for uninsured, low-income consumers. With its any door approach, consumers who present with medical conditions are screened for behavioral health issues and vice versa. Comprehensive assessmentsPHQ-9, GAD-7, Screening, Brief Intervention and Referral to Treatment (SBIRT), and screening for social determinants of healthare administered for every consumer to identify red flags so care coordinators can step in when other services are needed.

Hill Countrys onsite integrated care team has six key professionalsthree primary care professionals (a registered nurse, a licensed vocational nurse, and a medical assistant), a behavioral health coordinator (a social worker), a behavioral health consultant (a licensed clinical social worker), and a substance use counselor. Hill Country also operates 12 complex care programs with different payers. In one such programintensive outpatient case management funded by Partnership Health Plan of Californiathey wrap additional nursing, behavioral health services, and case management around medically complex consumers. We are incentivized by a per member per month (PMPM) model to do whatever we need to do, said Ms. Foster.

Their key to success? Having different clinical professionals onsite who can stick their head in, said Ms. Foster. If a consumer in a counseling session complains of chest pain, the behavioral health professional can immediately grab a primary care professional.One thing to watch out for is the different culture that behavioralhealth professionalshave to get used to while working in an FQHC. They have to get used to shorter visits and interruptions when they have to step out or bring in other team members for unplanned check-ins on co-occurring issues. Staff have to learn to be flexible and patient-centered, not directive, Ms. Foster suggested.And the FQHC sometimes ends up eating the cost of either the behavioral health or the physical health visitdue toarcane rules that dontpermitclaims to be submitted for two visits on the same day. Almost 75% of our consumers drive 35 miles one way to see us, so asking people to come multiple times a week or month isnt always the best for them, explained Ms. Foster.

Technology smooths the path at Cowlitz

Cowlitz Family Health Center uses its technology platform to facilitate its integrated care model. A single electronic health record (EHR) for each consumer that encompasses primary care, dental, and behavioral health helps to coordinate care. We have a whole person record but we had to firewall the substance use disorder information because of 42 CFR Part 2 restrictions, explained Mr. Coffee. Cowlitz Family Health Center is also an FQHC. Their integrated care model offers primary care, dental, behavioral health, and care coordination services at every one of over a dozen locations in Cowlitz County, Washington. They also provide health care, nutrition assistance, and social service referrals to pregnant women, mothers, and infants and children up to age five.

Cowlitz has leveraged its EHR to navigate the maze of multiple payers with varied reporting requirements. Before integration, we used to have four health plans for each person, said Mr. Coffee. Cowlitz still has to work with four to five different managed care organizations overall, and report different outcome measures to each. But theyve customized the EHR to feed the required data into different payer systems. In addition, Cowlitz executives meet with each payer on a monthly or quarterly basis to assess the gaps in care and possible remedies.Clinical professionals use the EHR text chat function to interact and coordinate care on the go. However, when consumers are referred outside the FQHC for specialty services, lack of interoperability makes the flow of information a one-way street, laments Mr. Coffee.

The sessionprovidedsome great lessons from three organizations that are making integration work for consumers.Many of the approaches they describedintegrating data, a one-stop service approach, and financial incentive alignmentare useful as executives look at optimizing their integration efforts.For more on integration, check out these resources in TheOPEN MINDS Circle Library:

For more, join us on September 29 for the webinar,Delivering Better Care Through Better Coordination featuring AJ Peterson, vice president and general manager of interoperability at Netsmart; Michael George, director of information technology at Lutheran Senior Services; and Sharon Hicks, senior associate at OPEN MINDS. The speakers will discuss howby using a single, integrated EHRproviders in all care settings can gain a comprehensive view of the consumer to effectively treat the whole person. Learn how technology can enable smooth transitions of care while relieving clinical burden and improving health and financial outcomes.

Continue reading here:
The Path To Integration Depends On Where You Sit | OPEN MINDS - OPEN MINDS