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Levels of Integrated Health Care


As our health system continues to change on both the primary and behavioral delivery systems a lot of discussion is taking place about the collaboration and integration of these two systems. As with any change a method for evaluating and then determining what works best is always one of the first steps. Primary care and behavioral health are not one in the same. Primary care is precise with very specific diagnosis and a prescribed method for treating the patient. If a patient breaks their leg the doctor will evaluate the extent of the break and what needs to be done to insure the best result. Behavioral health does diagnosis the patient but the diagnosis could change based on the needs and wants of the patient. The clinician often does not have a specific method for treatment. The ability for these two systems integrating will require a standard framework that is comprehensive enough to serve as a national standard for future discussion about integrated care.

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Topics: Integrated Care

Integrating Physical and Behavioral Health Care In a Health Home Model

As the behavioral health care system changes and becomes more aligned with primary care specific models are being developed to assist patients and the provider. Human services will no longer be a system of providing service. Service delivery will become more structured within specific models of care. The “Health Home” is one of those models that require care that is patient centered, coordinated across the health care spectrum, and provided by a team of professionals that is headed by the patient’s personal physician. In order for a patient to qualify for services in a health home they must have two chronic conditions one of which can be mental illness. Technology will be key to coordinating the services that will be provided. These include: Read More

Topics: Outcome-based health care, Integrated Care, EHR

How will Managed Care Affect Your Behavioral Health Organization

As behavioral health begins to feel the effects of managed care how is that going to change the way you do business. Managed care will effect and change every aspect of your agency. No longer will you get paid on the basis of numbers seen but instead it will be a system of measurement, both clinically and financially, driven by cost containment. Everyone you currently do business with will be increasingly aggressive in their demands for competitive prices that are paid through a system of quality measures that will determine success.

Budgeting will no longer be a process of multiplying the number of clinicians an agency has by how many clients they can see in a week. We are moving to integrated care a system that will be driven by primary medical care using behavioral health to reach medical goals in a very specific and structured process. What will be paid for is only what the client needs to reach their medical goals. When those medical goals have been met the patient will be moved to support services to maintain the medical goals through behavioral health.

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Topics: Integrated Care

Using Predictive Modeling in Heath Care with Medicare Populations

Electronic Health Records are like any tool that is used to assist patients in both primary and behavioral health. To be effective the EHR must be using the best available patient information to develop both a clinically sound and cost effective treatment plan. Predictive modeling combined with integrated care and automated technology will assist case managers in designing a plan that is efficient, high quality, and cost effective health care.

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Topics: Treatment, Integrated Care, EHR

Behavioral Health Payments in Value-Based Health Care

The current model of health care is about to change. The days of seeing a patient, billing, and then seeing them again is going away. Partly this is due to the Affordable Care Act requiring that medical care will become integrated with behavioral health. When a patient sees the doctor the process will cover the total person from the top of his/her head to their toes. Let’s explore how value based payment will affect primary as well as behavioral practice.

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Topics: Behavioral Health Care, Integrated Care, Behavioral health billing software

Preparing Psychiatrists for Integrated Health Care

Psychiatric residents today are training amidst an environment that is evolving faster than care. Policies, regulations, and limited resources attached to behavioral health are one side of the coin, while a fundamental shift to outcome-driven care is on the other. Integrated care – patients receiving mental health services within the context of primary care -  can help providers deliver patient-centered care.

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Topics: Behavioral Health Care, Integrated Care

Patient Portal: Parallel EHR Development

Why are patient portals more important than you think?

Patient portals create the means for the exchange of information between patients and physicians practices.  What was once considered a nice option for your EHR is becoming a necessity. Not all patient portals offer the same features.  It is important to make sure when purchasing software the patient portal is going to enhance the use of your EHR.

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Topics: Electronic Medical Records, Outcome-based health care, EMR, Integrated Care

What Is Integrated Behavioral Health Care (IBHC)?

Integrated behavioral health care is an emerging field within the wider practice of high quality, coordinated health care.  Integrated behavioral health care describes any situation in which behavioral health and medical providers work together. However, integrated behavioral health care addresses the integration of behavioral health and primary care and is defined as follows:

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Topics: Integrated Care

Raising the Bar: Mental Health Conference Outlines Changes in Behavioral Health Care

The Detroit Wayne Mental Health authority and Wayne State University in Detroit, MI co-hosted a conference entitled Raising the Bar that focused on improving mental health services.  These improvements would assure that persons would receive help in a more organized and focused process of care.  This is not a new theme for a conference on the topic of serving the mentally ill, substance abuse, and those with intellectual and developmental disabilities. 

For those who have worked in the system for many years the claim of improving service delivery has been a repetitive theme.  Often the improvements are driven by funding and not the needs of the person in care.  Let’s take a look at the proposed changes that are going to raise the bar:

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Topics: outcome-based treatment program, Behavioral Health Care, Integrated Care

Implementing a Mental Health Recovery Model in Integrated Care

As more health systems begin to integrate behavioral health and primary care services as a way to improve outcomes and reduce costs, there has been an increased focus on identifying the most effective treatment approaches for helping people overcome mental health and substance use disorders.

Growing evidence and acceptance shows that a recovery-oriented approach to behavioral health care is an important part of health care delivery. This approach not only engages the individual as an active participant in his or her own treatment, it also engages those closest to the consumer as partners — through peer and family support programs, community-based organizations and advocacy groups. By exercising best practices of promoting wellness and preventing illness, informed and engaged consumers can dramatically improve outcomes and reduce costs.

What is “recovery?”

Recovery is a process of change through which individuals living with a mental health and substance use disorder improve their health and wellness, live a self-directed life, and strive to reach their full potential. When someone has achieved recovery, he or she is living a healthy, purposeful life that includes meaningful activities and relationships that offer support and hope.

Whereas the medical model of treatment tends to focus on symptoms, illness and individual deficiencies, the recovery model focuses on strengths, shared power and personal achievement. Simply put, the recovery paradigm empowers those who live with mental health and substance use conditions to recognize they can live purposeful lives. Another important aspect of recovery-oriented treatment programs is the emphasis on family involvement. These programs help family members understand the process of recovery and how to become active supporters of their loved one’s efforts.

Recovery-Oriented Approach in Public Health Systems

In recent years, counties and states throughout the country have partnered with Electronic Health Record (EHR)  firms with Medicaid expertise to assist in developing and implementing recovery-oriented behavioral health systems of care. EHR’s, have helped several public health systems successfully transform their mental health and substance use treatment programs to focus on helping people achieve long-term recovery. In communities throughout the country, as shown below, EHR companies have worked in partnership with local stakeholders to develop recovery-oriented behavioral health programs that address the specific needs of the consumer and increase access to care, while helping public agencies get the most out of limited public health resources.

  • Transforming care through peer support: Peer services are an integral part of a recovery-oriented approach to behavioral health care. A peer is an individual who has managed his or her own behavioral health issue and is in recovery. Peers are trained to help people currently dealing with a mental health or substance use issue by providing support, encouragement and links to community resources. The incorporation of peer support services into public mental health systems has resulted in better adherence to follow-up treatment, fewer unnecessary re-hospitalizations and significant cost savings for local governments.
  • Jail Diversion and Alternatives to Incarceration Programs: Many communities have experienced an increase in the number of offenders with mental health and substance use issues booked into local jails. Many of these offenders churn through the criminal justice system multiple times and experience numerous incarcerations; as a result, many local jail systems are overwhelmed and face increased operating costs. In collaboration with local governments, through the use of a outcome based EHR programs designed to reduce the number of times people with mental health and substance use issues spend in jail by redirecting them from the criminal justice system to community-based care.
    • Since 2009, an EHR has been used at the Regional Support Network (RSN) for Pierce County in Washington State. The RSN coordinates mental health care for approximately 134,500 Medicaid beneficiaries each month. In 2012, an automated electronic record assisted local public health and law enforcement leaders to establish the Community Re-Entry program. This program is designed to help reduce the time people with mental health issues spend in jail by redirecting them from the criminal justice system to appropriate treatment and support services in the community. The program also helps reduce and prevent future run-ins with law enforcement by helping these individuals get assistance once released, including help finding housing, assistance with applying for benefits, and family and child care services.
    • In Salt Lake County, UT, an electronic health record is used to manage mental health and substance use services for approximately 100,000 Medicaid beneficiaries. It’s estimated that nearly 60 percent of individuals in a county jail have a mental illness. The ability to coordinate care and link these people to services is integral to keeping them out of the criminal justice system, and to supporting their successful recovery in the community. The county has collaborated with an EHR company to establish programs that quickly identify adults with serious mental illness who are booked into a county jail. Staff members then work with a local provider, the court and the legal system to transition those individuals to mental health services more quickly and reduce incidents of re-incarceration. These programs engage the individuals in mental health and substance use treatment services, thus reducing the individuals’ likelihood of recidivism and improving their chances of achieving recovery. 

As Medicaid programs face continuing fiscal pressures and increased demand for behavioral health services, implementing a recovery-oriented system of care is an important step in developing a care delivery system that results in improved outcomes and reduced costs.

Want to know more about how clinics can effectively integrate behavioral health and medical health? Download this guide:

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Topics: Behavioral Health Care, Integrated Care