Integrated Behavioral Health : What Have You Tried? How Has It Worked? What Next?

1. Integrated Behavioral Health:What Have You Tried? How Has It Worked? What Next? Kirk Strosahl Ph.D. Mountainview Consulting Group, Inc. E-mail: mountainconsult@msn.com Website: www.behavioral-health-integration.com

2. Webinar Objectives • Appreciate the range of integration models and options • Characterize what you have done thus far • Assess successes and setbacks thus far • Consider six domains of integration activity • Conduct a self assessment of your integration program

3. The Continuum of Integration

4. Two Perspectives On Population-Based Care Vertical Integration Depression Clinical Pathway Chronic Depression Major Depression Dysthymia & Minor Depression Adjustment & stress reactions with depressive symptoms Horizontal Integration Panel Population Specialty Consultation Integrated Programs General Behavioral Health Consultation

5. Dimensions of Integration • Mission • Clinical Service • Physical • Operational • Information • Financial

6. Mission Integration • The extent to which the behavioral and general medical service systems are pointing toward the same health objectives, goals and strategies • Rule: The goal is to improve the “health” of the entire population, not just to treat the sick

7. Clinical service integration • The degree to which general medical and behavioral providers seamlessly engage in assessment, intervention, and follow up activities • Rule: The more co-management processes, protocols and assessment tools, the better

8. Physical integration • The degree to which the general medical and behavioral health providers work in the same space, allowing for instantaneous access to care • Rule: Co-location is NOT the same as integration

9. Operations integration • The degree to which the general medical and behavioral health providers work off the same clinic “platform” • Rule: The more operations processes are shared (scheduling, reception, QI, support staff), the better

10. Information integration • The degree to which the general medical and behavioral health providers can access real time patient care information • Rule: Separate charts and sequestered information are the bane of our professions

11. Financial integration • The degree to which general medical and behavioral health services are funded as a “basic” form of health care • Rule: Integrative behavioral care should be financed as a “core” primary care service

12. So. . .How integrated are we? • General Rule: The more you have completely accomplished the six domains of integration, the more integrated you are! • It’s that simple. • Except that the “devil is in the details”!

13. Qualities of A Successful Integrated Behavioral Care Service • Provides timely access for PCP • Service is integrated within primary care setting • Service is viewed as a form of primary care • Service is provided in collaboration with the PCP • Service is provided as part of the health care process

14. Qualities of a Successful Integrated Behavioral Health Care Service • Goal is to increase impact of PCP team interventions • Goal is to consult with and train the PCP to produce better outcomes • Improved clinical outcomes, satisfied patients and health care providers, and managing productivity and financial risk are key targets