Will integrated care provide you with better care?

Laura Galbreath, M.P.P., Director
SAMHSA-HRSA Center for Integrated Health Solutions, National Council for Behavioral Health

galbreathWalk into a community behavioral health or health center right now and you’ll probably see posters about this great new health care approach called integration. What is integration, though? And what does it look like?

As our health care system strives to improve patient health outcomes, improve the quality of care, and make care affordable, a collective light bulb has gone off. To achieve these three aims—known by the phrase “the triple aim”—we have to recognize and treat people’s physical and emotional health, and that means changing how we deliver care. Integration is one approach receiving a lot of attention for its promise to achieve these aims.

When my friends and family ask what integration is, I explain it like this: Integration improves access to mental health and addictions treatment by making that care a routine part of a visit to primary care, whether at the lowest level of integration (improved communication among providers) or the highest (a merged practice that includes both medical and mental health services). Integration also improves the quality of recovery by addressing the physical health care needs of people with mental illnesses and addictions.

How It Works

In practice, your primary care doctor may ask questions on your health history form to get a sense of your emotional state and use of substances like alcohol and tobacco.

In the exam room, the medical team may ask additional questions to assess whether you could benefit from speaking with a mental health professional or from treatment for any untreated mental health conditions.

Even if you do not have a diagnosed mental illness or addiction, your primary care doctor may invite a behavioral health professional into the exam room to help you identify strategies to support your health goals, like remembering to take your medication on time, reducing your salt intake, etc.

Your primary care doctor may take on an increased role in coordinating your care with your other providers, like your counselor or case manager, and making sure that all your providers are clear about the medications you take.

Such care coordination is just as important to your mental health provider. A member of the mental health team will also likely help coordinate your care among all your different providers, help you understand any physical health conditions you may have, like diabetes, and teach you strategies to manage your conditions.

You may wonder what’s so new about this. Perhaps you thought this was already the norm.

Unfortunately, this coordination hasn’t been implemented by or required consistently from providers. It’s a simple concept, but there is a lot involved. Integration changes the way health care is delivered and requires quality care, adequate funding, technology to share information, and identifying the best health professional to coordinate a person’s care.

However, given what we know about how much more prevalent chronic health conditions like heart disease, diabetes, obesity, and tobacco dependence are among people with mental illnesses and addictions, it is heartening to know that our health care system is finally working toward reconnecting the mind and the body.

How can you ensure that you are receiving the best and the most coordinated care?

Next time you go to your mental health provider or primary care office, ask how they are coordinating your care with your other providers. It’s the first step in making sure you receive the most out of your health care.

Resources

If you’re confused about all these different terms in health care reform, you’re not alone! Here’s a glossary about integration and some other resources:

Learn about Patient-Centered Medical Homes
Learn about Medicaid Health Homes

Check out these videos for examples of how integrated health care can work:
Provider Example
Consumer Example

Your Turn

Share your thoughts and experiences!

What are some examples of how your physical health impacts your recovery goals?

Would having primary care services located where you receive mental health or addiction treatment make you more likely to get a check-up?

When trying to manage the information coming from different medical and behavioral health providers, what is the toughest part?

7 comments
ReeneeCummins
ReeneeCummins

Bravo Laureng!  I too, have strong doubts about a GP understanding medicine for mental illness and it's interaction with other treatment.  There is also the insistence to move to generics WHICH ARE NOT THE SAME AS THE BRAND NAME AND HAVE DIFFERENT INTERACTIONS.  My life is a living hell because of someone (not my psychiatrist) who INSISTED I take a generic to "save the insurance company money".  I have not had a well day since.

laureng
laureng

Thanks for the information. It concerns me that a primary care Dr., with perhaps a six-week routine in Med School, has the experience to deal with major mental illnesses. Yes, the physical complications may be present, percentage wise, substance abuse seems to be a bigger factor. I advocate and am an active participent in my treatment plan. With Bipolar - I see an individual therapist, attend a dual diagnosis group, and am active in a 12 step program. I was always told to learn everything I could about my illness. After an appt with my PC physician, who thought an SSRI antidepressant would be my next option. I asked the question, Can't SSRI's put people at risk for manic episodes? He said he wasn't sure. I found a Med Specialist/nurse Practitioner and we've made great progress. So I guess I would want the Dr's up to speed, psychiatrically speaking.

laura3530
laura3530

Thanks for sharing your feedback. Transforming how healthcare is delivered is tough work and it's even harder to make sure that care is truly person-centered. What are my health and wellness goals and how can I work with my clinical team to support the goals using a wide range of treatments and community supports. We need to be personal advocates for our health as well as community advocates to help improve the health care provided in our communities.

Randikranz
Randikranz

I believe integration is a necessary step in providing the best healthcare possible. Without a healthy brain it is very difficult to have a truly healthy body.

Iris40
Iris40

Integrated health is a good step in the right direction.  Primary care doctors and NPs should be assessing mental health.  They should be aware of the treatment patients with mental illnesses are getting.  Of course, as with any complicated medical issue what is available at the patient's "medical home" may not be enough.  For example, most mental health care authorities advise patients to find the best therapist for them.  It may take several tries before you find one you can work with successfully.  The trust and frank interaction between the therapist and the client is the most important element of therapy, even CBT.  So, the medical home may not be able to help everyone. 

GregSimon
GregSimon

When our health care system (Group Health Cooperative) was implementing an electronic medical record, mental health providers were concerned about primary care doctors seeing information about mental health care.  So we interviewed mental health consumers about this, asking "Would it be OK with you if your primary care doctor could know you are getting mental health care?".  The most common answer we got was "You mean they don't know that already!?".  People who live with mental health conditions already know that their minds and bodies are part of the same whole.  But they are still waiting for the health system to realize that.

Greg Simon (chair of Depression and Bipolar Support Alliance scientific advisory board)

ReeneeCummins
ReeneeCummins

Of course this WON'T improve my care.  I will be induced to take MORE MEDICATION for borderline physical conditions.  This may interact with my antidepressant or give me more side affects to deal with.  I then will be sent to a dietitian because I could loose 20 pounds.  Then there will be the stress of a diet that I have to explain over and over to friends and family why I can't go out to dinner with them. This anxiety patient has taken this path.  Until we come to an understanding that big pharma wants everyone to be on as many pills as possible, and few clinics offer alternative options, this experience will drive people away.  Oh, and have doctors ask questions that might get you diagnosed as "crazy"!?!  Nobody will go to the doctor then.