eSolutions: Integration Partnerships – A Love Story
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
In This Issue:
Feature Article: Primary and Behavioral Health Care Partnerships: The Courtship
Quick Tips: Preparing for Integrated Service Delivery: The Wedding
Grantee Spotlight: Weber Human Services & Midtown Community Health Center: The Marriage
Happy Valentine’s Day!
It’s Valentine’s Day — the one day of year when everyone is thinking of love. This special issue of eSolutions details a love story between primary care and behavioral health. We hope you’ll come away with plans for your own marriage, knowing that CIHS is always available to add fuel to your flame.
By Cheryl Holt, Director of Training and Technical Assistance, CIHS
Across the nation, an emphasis on primary and behavioral healthcare integration is leading to initiatives that address the full range of healthcare needs of individuals living with mental illnesses and addictions. The historic silos of care have begun to crack, allowing healthcare professionals in both systems to engage in partnerships to serve vulnerable people with behavioral health problems.
For disparate groups to work together, it takes considerable planning, patience, and commitment. Despite the fact that both primary and behavioral healthcare fall under the “healthcare” umbrella, they can display vast differences in perspective, including major variation in cultures, funding streams, philosophies, and overall treatment approaches. Therefore, collaborations to serve individuals with behavioral health disorders are no easy task for these two groups — yet many across the nation are doing just that. Indeed, the mission of improved care and health outcomes for people with behavioral health problems is far greater than protecting the systems’ differences, and many provider organizations find it worthwhile to devote the necessary time, energy, resources, and focus to develop strategies to streamline the integration process. Whether services are provided in a primary care or behavioral health clinic, such collaboration will enhance care and health outcomes and that serves everyone’s interests.
The eight steps below are adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD (Behavioral Health Management, May 1998) and describe the foundational steps to a successful behavioral health–primary care partnership:
1. Establish the Partnership’s Mission
A successful partnership requires a shared vision. Usually the partnering organizations merge their goals into a partnership mission statement. In addition to imparting this shared mission with all involved, the partners must identify and empower frontline champions who will bring energy to the mission and motivate others.
2. Identify a Common Language
Primary and behavioral health care providers speak different languages; a successful partnership requires a common language. Clear communication enhances mutual understanding of cultures, roles, and expectations. Common language will become increasingly important as the partnership progresses; each organization comes to the partnership with notable differences between contract deliverables, medical records, coding, management structure, procedures, and even the language used to describe the individuals served.
3. Maintain Pacing, Flexibility, and Capacity
Successful partnerships temper expectations. Regular meetings and ongoing communication around mutual goals and disappointments helps address issues as they arise. In addition, maintaining flexibility helps sustain a healthy partnership.
4. Develop Shared Solutions
Compromise is important for successful partnerships. Decision makers must remain open to new ideas and problem solving and develop shared solutions to maximize organizational efficiency and capacity.
5. Determine Expectations
New partners should pilot their joint project to allow for evaluation and the adjustment of expectations to ensure both partners are on the same page. In successful partnerships, conflicts are inevitable and are discussed openly on an ongoing basis.
6. Delegate Trust
Trust is inherent in a successful partnership. Successful partners focus on building trust and continually solicit feedback from partners at all levels. Face-to-face meetings help establish and maintain such trust and create a forum for the checks and balances that ensure mission fidelity.
7. Create Empowerment
Success depends on the involvement of all staff members and stakeholders, as well as the empowerment of champions at all levels. These champions move the mission forward by fostering buy-in among staff. Successful partners create a forum that allows open communication for all those involved to solicit positive and negative feedback — such communication maintains focus on the mission.
8. Measure Outcomes
Determine the outcomes to be measured early in the project, and be prepared to modify outcomes as needed. Don’t overlook the benefits of partnership that include more efficient allocation of resources, less duplication of services, increased choice among clients, and the synergistic effect of the partnership resulting in enhancing the lives of those we serve.
These eight steps for success will help bridge the innate differences between primary care and behavioral health organizations, fostering a successful partnership. Poor communication and lack of planning have derailed far too many promising partnerships. Careful preparation at the onset will nurture a productive mission-focused partnership that effectively addresses health disparities among people with behavioral health issues.
For more information or technical assistance on building primary care–behavioral health partnerships, contact CIHS. Also, check out CIHS’ resources related to contracts and MOUs.
Nationwide, forward-thinking health providers are leading efforts to integrate primary and behavioral healthcare. There are many models of integration, including co-location, care coordination, and health homes. Regardless of the model employed, consider these quick tips when preparing for integrated service delivery.
1. Start with a Customer Service Perspective
Initial planning must focus on providing the best service to patients. Consider what the ideal patient experience will look like and start with that end-goal in sight. Providing a pleasant environment with a customer-centric flow that effectively integrates service delivery will result in satisfied customers and providers.
2. Plan Strategically
Successful integration may not occur if primary care and behavioral health staff cannot interact regularly. Seeing and consulting frequently promotes a sense of teamwork, while physical distance prevents interaction and reduces the likelihood of true integration. Locating primary and behavioral health services in separate hallways, wings, or even floors can hinder the integration of services by discouraging interaction. Carefully plan the workflow and relocate a few offices, if necessary, to maximize success.
3. Encourage Warm Handoffs
Encouraging the “warm handoff” is a vote of confidence from one professional to another; it greatly increases the likelihood of client follow through. When behavioral health and primary care professionals are in close proximity, even the busiest providers are able to take a moment to make this brief, but valuable, introduction.
4. Value Flexibility
Many behavioral health organizations rely on a rigid method of scheduling based on the clinic’s convenience rather than the client’s. Historically, this method has been a challenge for clinics and the people who seek services there. No show rates soar while administrators struggle to get clients to adhere to the clinic’s methods of service provision. This is costly for the clinic and frustrating for the client. Behavioral health clinics can learn from their primary care brethren, opting for more flexible scheduling to meet the demands of the clients. Open access and same-day scheduling are viable options to explore.
5. Engage Primary Care Staff in Planning Workflow
Engaging both primary care and behavioral health staff in planning workflow fosters buy-in and prevents the need for future modifications. Workflow in primary care settings differs greatly from that in behavioral health settings, and vice versa. Negotiating the flow for integration ensures smooth service delivery and maximizes staff productivity.
6. Share Reception
One front desk promotes the sense of seamless service delivery and greatly simplifies the process for clients and staff. Having separate locations for checking in is an extra step in the workflow and is not customer-centric.
7. Plan for Frequent, Regular Case Consultation
Weekly treatment team meetings offer a forum for integrated case discussion that can supplement ongoing, daily consultation and enable providers to discuss difficult cases and benefit from colleagues’ expertise. It also further promotes the sense of teamwork.
Visit CIHS for more information on preparing for integrated service delivery or to access technical assistance.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration (PBHCI) grantees. Each issue of eSolutions profiles a grantee’s work.
Weber Human Services, a community behavioral health provider and PBHCI grantee, and Midtown Community Health Center, a community health center, have successfully bridged the chasm separating behavioral health and primary care in their community through jointly founding the Wellness Center. And they have done it in a manner that, deceptively, appears effortless.
While most collaborative efforts struggle, these innovative healthcare providers in Ogden, Utah thrive in their commitment to a shared vision of improving health outcomes for their community members with behavioral health disorders. Karen Bassett, Wellness Clinic Project Director, attributes their success to the following:
• The active involvement of both CEOs and staff at all levels has enabled seamless integration. In fact, the Wellness Center identifies as neither behavioral health nor primary care, the team is fully integrated.
• Dedicated face-time for all team members from the onset enables timely generation and implementation of ideas and solutions. This includes high-priority monthly meetings and biweekly clinical consultation meetings to coordinate care and address ongoing client issues.
• An embedded mechanism for sharing clinical information and other data (e.g., shared clinical registries, continuity of care documents) enables care coordination among providers.
• A strategically planned physical environment places behavioral health and primary care providers across the hall from each other, and supports a coordinated approach to pharmacy, labs, and scheduling.
• A customer service focus provides process ownership to the entire team. The Wellness Clinic team routinely does walkthroughs from the client perspective to identify barriers for service delivery, addressing identified issues quickly.
The collaborative efforts of Weber Human Services and Midtown Community Health Center have made a lasting change in treatment options in their community.
For more information on the Midtown/Weber Human Services Wellness Clinic, visit www.weberhs.org. Learn more about the PBHCI program and grantees.
Research Review of Wellness Programs for People with Serious Mental Illness
CIHS engaged the Dartmouth Health Promotion Research Team, under the leadership of Stephen Bartels, MD, MS, to conduct a comprehensive, systematic review of published research literature addressing non-pharmacological lifestyle interventions aimed at reducing obesity and improving fitness for people with serious mental illness who are at risk of myriad chronic conditions and premature death.
Interim Billing and Financial Worksheets for States
CIHS continues to developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work.
Hot Topics: News & Resources
2010 National Survey of Substance Abuse Treatment Services
SAMHSA has released the 2010 National Survey of Substance Abuse Treatment Services (N-SSATS). This annual survey is designed to collect data on the location, characteristics, services offered, and number of clients in treatment at alcohol and drug abuse facilities (both public and private) throughout the 50 states, the District of Columbia, and other U.S. jurisdictions.
Free Newsletter on Alcohol and Drug Abuse in Indian Country
SAMHSA, in collaboration with the Office of Justice Programs, is pleased to announce the release of the first issue of Prevention and Recovery, a new quarterly newsletter that highlights successful practices and stories related to alcohol and drug abuse in Indian Country.
Health IT Toolboxes: Your Resource for Implementation
HRSA has developed a series of Health IT Toolboxes to help health centers and safety net providers navigate the process of implementing health information technology to improve patient care. The toolboxes compile planning, implementation, and evaluation resources.
New IOM report on Living with Chronic Illness
Living Well with Chronic Illness: A Call for Public Health Action, developed by the Institute of Medicine, identifies the population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals at risk of developing a chronic disease and those with one or more diseases. The report includes recommendations to inform major federally-funded programmatic and research initiatives in health; policy makers concerned with health reform; managers of community-based and public health intervention programs; private and public research funders; and individuals living with one or more chronic conditions.
Peer Recovery Support Services: Initializing, Stabilizing, and Sustaining Long Term Recovery
Join the National Association of Alcoholism and Drug Abuse Counselors on February 15 for a webinar on how people recovering from addiction can help others by serving as peer supports and creating recovery-supportive environments. Through participation, you can earn one continuing education credit, as well.
Accountable Care in the Safety Net
The Health Management Associates prepared Accountable Care in the Safety Net for the Blue Shield of California Foundation. This document makes the case for including safety net providers in developing and implementing accountable care organizations.
Breaking Bad Habits
The article, Breaking Bad Habits: Why It’s So Hard to Change, explores habits — how they are formed, broken, and changed , as well as the struggle most people have when trying to break or change habits.
Webinar: Motivational Interviewing for Better Health Outcomes
Date: February 23, 2012, 1:00-2:30 pm EST
Register: Registration available soon at www.integration.samhsa.gov
Webinar: Chronic Pain: An Approach for Community Health Centers
Date: Tuesday March 6, 2012 from 1-2:30 pm EST
Register: Registration available soon at www.integration.samhsa.gov
Visit the CIHS website regularly for upcoming webinars. Also, Check out CIHS’ webinar recordings and presentations, including:
Webinar: Addressing Obesity and Chronic Illness among People with Mental Illnesses: What Works?
Date: February 13, 2012, 1:00-2:30 pm EST
To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA-HRSA Center for Integrated Health Solutions” from the options listed.
Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.integration.samhsa.gov , e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; eSolutions Editor: Heather Cobb
The SAMHSA-HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.