A large cross-section of the population is endowed with both physical and psychological disabilities that manifest in chronic conditions or complex illnesses. This diverse group of individuals has complicated needs that frequently require a combination of medical, physical, psychological and social interventions. These people require an amalgam of services delivered by multiple providers in several settings. This presents major challenges to both patients and practitioners: coordinating patient care, ensuring services are delivered, managing crises, and coping with individual stressors.
Primary Care Physicians (PCPs) are usually the first professional contact a patient has. That means they also tend to be the first line of defense when it comes to diagnosing behavioral health conditions. Since these physicians are generalists, they typically do not have much training in behavioral health treatment. However, if PCPs are diagnosing the majority of these conditions, an integrated healthcare model is necessary. Many times, the specialists who treat the body have little interaction with the specialists who treat the mind, which is often ineffective.
What is Integrated Healthcare?
Integrated healthcare is a “buzzword” in today’s medical landscape. Integration refers to a coordinated, seamless and easy to navigate service for patients. Primary care physicians, nurses, specialists, and mental health professionals all work together. As medical services become more cost prohibitive for both patients and professionals, solutions are needed. Healthcare integration refers to the process of “bringing together of inputs, delivery, management and organization of services as means of improving access, quality, user satisfaction and efficiency”.
Benefits for Doctors and Patients
Integrated healthcare solutions facilitate primary care physicians (PCPs) by providing a framework for them to apply their skills and expertise to treat patients holistically. By capitalizing on the clinical strengths of a PCP, healthcare costs will naturally go down. When a PCP refers a patient to a specialist (e.g., psychiatrist) a “triangle” is created. This triangle consists of the PCP, specialist and patient. In order for this triangle to be effective, all three parts must not only communicate with one another, but also agree on a specific overall treatment plan. This can become complex if there is little communication or consensus among the three, causing treatment to be ineffective and increasing costs for both patient and providers.
Integrated health care removes the “triangle” and positively supports a number of medical practice operations such as:
- Funding: centralized pooling of funds for financial stabilization
- Administrative: decentralization of individual responsibility; needs assessments; joint purchasing
- Organizational: mutual location of services; discharge and transfer agreements; interagency planning and budgeting; consolidation/common ownerships/mergers
- Service delivery: joint trainings for staff; centralized information on patients; interdisciplinary teamwork; around the clock coverage for patients
- Clinical: standard diagnostic criteria; uniform assessment procedure; joint care planning; shared clinical records; continuous patient monitoring; common decision support tools; regular patient and/or family contact
When medical services are integrated, there are significant benefits for the patient as well. The number of stages in an appointment and number of visits required to a facility are minimized. Integrated healthcare provides patients the ability to access both physical and mental health care at a familiar location. Primary care and behavioral health providers collaborate using shared data to treat patients as a whole. The comprehensive health model is linked to several projected benefits: increased quality of care, reduction of medical errors, improved patient outcomes, reduction in treatment plan disparities, cost savings, and improved patient safety (Kodner, 2002).
Successfully Applied Models
Integrated health care models have been successfully applied across the country. The Integrated Behavioral Health Project (IBHP) was launched in 2006 with the mission of integrated behavioral health services into primary care settings in California. An investigation into seven grant-funded sites demonstrated statistically significant improvements in patient mental, physical, and overall health. IMPACT: Improving Mood followed 1,800 depressed, older adults from 18 primary care clinics across the United States for two years. Half of the patients were assigned to receive care normally available in their primary clinic, and half were assigned to the IMPACT model that integrated depression treatment into primary care and other medical settings (Cashin, Scheffler, Felton, Adams & Miller, 2008). This model of care was found to be more than twice as effective as usual care for depression, improve physical and social functioning of patients, improve patients’ quality of life, and reduce overall health care costs (Unutzer et al, 2002).
Technological Advances for Integrated Care
Technology has aided the integrated of behavioral health into primary care by developing a variety of electronic methods that are used to manage information and make data-based decisions about people’s health and care. These tools allow secure and private records for patients and make health information available electronically when and where it is needed. Using these tools can improve the quality of care and reduce care-related costs. Health care technology makes it possible for multiple providers to concurrently manage patient care. Electronically managing patient care eradicates the need for physical proximity to their patients and other providers.
In primary care, examples of such advances include: (1) clinical diagnostic decision-making support; (2) computerized disease registries; (3) computerized provider order entries; (4) consumer health IT applications; (5) electronic medical record systems (EMRs, EHRs, and PHRs); (6) electronic prescribing; and (6) Telehealth.
Using technology in an integrated setting allow for accurate and complete information about a patient's health. That way, providers can give the best possible care, whether during a routine visit or a medical emergency. It also helps physicians better coordinate the care given. This is particularly important if a patient has a serious medical illness. There are several platforms available to assist with the referral process to specialists. One such technology, Mindyra, provides the PCP with an individualized list of referrals, including a list of appropriate specialists who meet the patient’s criteria, including location and insurance coverage. Once a specialist is selected, the specialist and PCP begin a dialogue concerning patient’s treatment. Mindyra has an “impairment index” that can be utilized to track the patient’s treatment progress and make evidence-based treatment plan decisions. This flexibility allows the PCP and specialist to easily and seamlessly collaborate about a patient’s treatment plan. Other examples include Lyra Health that matches mental health professionals to patients based on the referring condition, and Quartet Health, a concierge service that connects patients to mental health professionals.
Technology-aided integrated health care also helps to diagnose health problems sooner and reduce medical errors. This is important since diagnostic error is the number one cause of malpractice claims for PCPs. Mindyra has a ten minute assessment test and other diagnostic tools that can help PCPs and other physicians work together with a patient to accurately and systematically diagnose behavioral disorders, helping to eliminate some of the guesswork on the part of the clinician.
When faster and more accurate diagnosis can be performed, prescription drug issues can also be lessened. If prescribed medication is right the first time, costs will be reduced and PCPs can create a customized, evidence-based treatment plan for their patient. Since patients and their families will receive a more comprehensive view of the behavioral health issue and how to solve it, the stress and burden of the problem will be less for both patient and family members.
Using technology for integrated care also ensures the safe sharing of medical information with patients and their family over the internet. This enables patients’ families to fully participate and take part in health-care related decisions. Using software tools, such as Mindyra, treatment outcomes can also be monitored. Everyone – the PCP, clinical specialists, the patient and family – can follow the patient's progress.
Integrated care between a specialist, PCP and patient can be very effective with the proper resources at hand. This process of using the latest technology greatly increases collaboration and communication among the triangle. Such an efficient system that breaks down barriers will reduce healthcare costs across the board. The current fragmented healthcare system in place not only increases costs due to inefficacy, but also puts patients’ well being at risk.
Integrated healthcare is a means of seamlessly coordinating behavioral health and primary care for patients and their families. When organizations are structured in an integrated fashion, there are patient care, service delivery, and financial benefits. There are technological tools that aid health care professionals in referring patients to a specialist, tracking a patient’s progress, and connecting care to other providers. Using these tools leads to more evidence-based decision-making and collaborative care for patients. Integrated care is the way of the future, as it uses technology to inform physicians and support patients.