In general, the reasons that mental/behavioral health and primary care organizations need to integrate care are abundantly clear:
- A 2011 study found that 34 million adults—17 percent of American adults—had comorbid mental health and medical conditions.
- Another study found that emergency department visits were 42 percent lower among a group that received integrated primary care services along with mental health care when compared to a group that received primary care separately.
- Eight psychiatric hospitals recently targeted better coordination of care in an inpatient environment with support services post-discharge. After implementing the program, the readmission rate among the participating hospitals fell from 17.7 percent to 10.4 percent.
But in the drive to integrate, do providers really understand what they, as an organization, are trying to accomplish? If they don’t, will they be able to improve outcomes and cost efficiencies in a manner similar to those above? An organization must understand how care integration will specifically impact their internal processes—they must understand their personal “why”—if they are to be successful in their integration initiatives. Here are a few tips to build comprehensive understanding as to how integration applies to your unique organization.
It’s helpful to define exactly what we mean by integration, to maintain a proper focus on what areas of the overall system need improvement.
Monica E. Oss, President of OpenMinds clarifies the difference between integrated and coordinated care. She defines coordinated care as a competency—it’s the end result that the constituencies outside of the care providers, such as the consumers and payers, are demanding. When visibility over an individual is improved, and duplicative services and costs are reduced, the end state can be seen as coordinated care.
But integrated care can be defined as system improvements designed to achieve the end goal of coordinated care. Oss believes that integration is more than communication between providers, it should cover operation of the system as a whole, including five key domains:
- Service delivery
Once there is a better understanding of what integration really means, it’s helpful to understand what level of integration we’re talking about. Organizations such as ACOs, medical homes, health homes, disease statement management programs, wraparound services, and coordinated care programs all provide integrated care management—they are providing management of services coming from different sources. By comparison, integrated service delivery is the delivery of services typically all from a single source.
What’s integration worth?
So how does an organization know if integration efforts are paying off? If an improvement cannot be measured, then is integration happening simply for its own sake?
Measuring the clinical benefits of integration is a topic we’ve covered previously, but another key consideration is how can an organization wrap its arms around the financial goals for an integration initiative? To address this, the Substance Abuse and Mental Health Services Administration (SAMSA) defines an effective business case equation for determining if integration efforts are really worth it. This formula starts with the seemingly obvious concept that any service provided must cost less than the revenue generated from that service.
For behavioral health integration, SAMSA developed the following formula: Cost of Screening (S) + Cost of Intervention Services (I) + Transition Costs (T) must be less than or equal to Screening Reimbursement (X) + Productivity Gains (P) + Reimbursement for Treatment (R). This formula is summarized as:
S+I+T ≤ X+P+R
Any organization evaluating their integration options needs to consider whether or not they have defined how they will come out on the plus side of this equation. That’s why the “why” is so important. Each practice is unique, and they how they define their integration goals should be unique as well. When the strategy moves beyond buzzwords and into, specific tangible goals, that’s when the end results can truly yield both clinical and financial rewards.
 Druss, B.G., Walker, E.R., “Mental Disorders and Medical Comorbidity.” Research Synthesis Report No. 21, (February 2011) Princeton, NJ: The Robert Wood Johnson Foundation.
 Boardman, J. “Health Access and Integration for Adults with Serious and Persistent Mental Illness,” Families, Systems, & Health, (2006), 24(1), 3-18.
 “Health Plan and Psychiatric Hospitals Reduce Readmissions by Reviewing Data and Developing Strategies to Improve Post Discharge Care,” Agency for Healthcare Research and Quality, (February 2011), Cited in: “Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes,” TrendWatch, American Hospital Association, (January 2012), http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf
 Monica E. Oss, “Keep In Mind The “Why” Of Integration,” OpenMinds, (September 29th, 2014), http://www.openminds.com/market-intelligence/executive-briefings/keep-mind-integration.htm/
 “The Business Case for Behavioral Health Care,” SAMHSA-HRSA Center for Integrated Health Solutions, http://www.integration.samhsa.gov/integrated-care-models/The_Business_Case_for_Behavioral_Health_Care_Monograph.pdf