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Why Should I Consider a Partner When Developing Integrated Services?
Presented by:
Kathleen Reynolds, LMSW, ACSW
Health Homes of the Future
Funding starting to open up for embedding primary medical care into CBHOs, a critical component of meeting the needs of adults with serious mental illness
Clinical Design for Adults with Low to Moderate and Youth with Low to
High BH Risk and Complexity
Primary Care Clinic with Behavioral
Health Clinicians embedded, providing
assessment, PCP
consultation, care
management and direct service
Partnership/Linkage with
Specialty CBHO for persons who need their care stepped up to
address increased risk and complexity with ability to step back to Primary Care
Clinical Design for Adults with Moderate to High BH Risk and
Complexity
Community Behavioral Healthcare Organization with an embedded
Primary Care Medical Clinic with ability to address the full range of
primary healthcare needs of persons with moderate to high
behavioral health risk and complexity
Food Mart
CBHOFood MartCBHO
Go it Alone
Pros One governing board
One executive team
One treatment plan
Negotiate with yourself
Cons Need to learn a whole new
business Consumer may want to
keep their existing primary care providers
Need additional accreditation
Need new Medicare/Medicaid numbers
Takes longer
Continuum of Integration
Co-Located Integrated
Key Element: Communication Key Element: Physical Proximity Key Element: Practice Change
Level 1Minimal Collaboration
Level 2Basic Collaboration at a
Distance
Level 3Basic Collaboration On-Site
Level 4Close Collaboration On-Site
with Some System Integration
Level 5 Close Collaboration
Approaching an Integrated Practice
Level 6Full Collaboration in a Transformed/ Merged
Integrated Practice
Behavioral health, primary care and other healthcare providers work:
In separate facilities, where they:
In separate facilities, where they:
In same facility not necessarily same offices, where they:
In same space within the same facility, where they:
In same space within the same facility (some shared space), where they:
In same space within the same facility, sharing all practice space, where they:
Have separate systems Communicate about cases only rarely and under compelling circumstances Communicate, driven by provider need May never meet in person Have limited understanding of each other’s roles
Have separate systems Communicate periodically about shared patients Communicate, driven by specific patient issues May meet as part of larger community Appreciate each other’s roles as resources
Have separate systems Communicate regularly about shared patients, by phone or e-mail Collaborate, driven by need for each other’s services and more reliable referral
Meet occasionally to discuss cases due to close proximity
Feel part of a larger yet ill-defined team
Share some systems, like scheduling or medical records Communicate in person as needed Collaborate, driven by need for consultation and coordinated plans for difficult patients Have regular face-to-face interactions about some patients Have a basic understanding of roles and culture
Actively seek system solutions together or develop work- a- rounds Communicate frequently in person Collaborate, driven by desire to be a member of the care team Have regular team meetings to discuss overall patient care and specific patient issues Have an in-depth understanding of roles and culture
Have resolved most or all system issues, functioning as one integrated system Communicate consistently at the system, team and individual levels Collaborate, driven by shared concept of team care Have formal and informal meetings to support integrated model of care Have roles and cultures that blur or blend
Partnerships
Pros
Requires collaboration
Can start quicker
Respects the history and competence of existing system
Financial benefits if public partner (FQHC, CHC)
Access to full continuum of care
Cons
Requires collaboration
Can be time consuming
Organizational Culture work must be done
Confidentiality
Partner may not want to partner
Partnership Options
With a CMHC and/or Addictions Agency
With hospital systems
With private for profit health clinics
With managed care organizations
Bi-directionality is key to successful agency partnerships
With CMHCs: The Business Case
Expertise
Payment for Care Coordination
Access to Care for More Severely Disabled
Improve UDS Elements
Selecting a Partner
What do we mean by “partner”?
A “partner” is a collaborator in service provision that works in another domain from the one you work in. A primary care clinic may partner with a behavioral health organization, or vice versa. Programs within the same organization may partner with each other, as well. A behavioral health organization may establish a health clinic at one of its sites. At the more advanced level, providers may partner in large collaboratives or networks to meet broader system or community needs.
Advanced Integrated Partnerships
A network of community health partners may collaborate with other organizations to address a range of needs in a single community. For example, a network of community-based organizations providing health and/or behavioral health services may partner with one or more hospitals.
Many communities have formed networks to partner with emerging Accountable Care Organizations, Regional Health Partnerships, and other emerging funding and coordination structures that may manage health and behavioral healthcare for large populations.
Partnership Checklist
Within the full array of primary health/behavioral health services (e.g., types of services, levels of care), identify and list the services that your organization already provides and the services that are needed but not provided or provided only to a limited degree (e.g., a large behavioral health organization provides a range of mental health and substance abuse services, but would like to include primary care services for clients without a primary care doctor).
For the services on both lists, identify all potential community provider partners that offer those services.
Prioritize potential partners who share your agency’s mission, vision, and values, including those that focus on helping the neediest members of your community.
If you do not recognize an obvious partner, identify where your clients currently receive those services. In a community with no FQHC or community health clinic, ask your mental health center or substance abuse treatment clients where they receive primary care, or vice versa. Those providers identified, even if they are
Partnership Checklist
Before approaching any potential partner, consider the following:
Is my organization proving services that our potential partner might perceive as a competitive threat? If so, are we prepared to be a supportive partner rather than a competitor?
What is my organization prepared to offer a potential partner? What is my organization’s business case? If you approach a partner by asking what they can do for you, it is likely you will be put off. Instead, think about what they may need and express willingness to help them, even if it is initially unclear how your help may be reciprocated.
Partnership Checklist
Does your organization have:
Timely and cost effective access to collaborative treatment, including curb side consultation?
Efficient service capacity — providing high quality services at the lowest possible cost?
Electronic health record capacity to connect with other providers and electronically transmit important clinical data?
Ability to focus on episodic care needs and treat to target models?
Ability and willingness to participate in bundled/shared risk payment models?
Outcomes that demonstrate that the organization can:
Engage clients in natural support networks
Help clients self-manage their whole health, wellness, and recovery
Reduce the need for emergency/high cost services for complex populations
Resources
www.integration.samhsa.gov
Health Behavior Change: A Guide for Practitioners by Pip Mason and Christopher C. Butler.
