21 Jan What you Need to Know about Levels of Integrated Health Care

As our health system continues to change for both primary and behavioral healthcare, 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 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 a 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 ensure the best result. Behavioral health providers diagnosis the client, but the diagnosis could change based on the needs and wants for a favorable outcome. The clinician often does not have a specific method for treatment. The ability for these two systems to integrate will require a standard framework that is comprehensive enough to serve as a national standard for future discussions about integrated care.

To begin the discussion, we need to look at six levels of integration that allow organizations to determine which care is best, based on specific benchmarks. All six models are broken into three separate categories within the framework– coordinated, co-location, and integrated care. Each category has two levels within each category that are designed to help organizations evaluate their degree of integration across several levels, helping to determine the next steps they want to take to enhance their integration efforts. 

Coordinated Care

Level 1: Minimal Collaboration

The primary care clinic and the behavioral health program are in different locations. Neither group is in contact with the other unless specific information is needed about a mutual patient. Through the use of an electronic medical record, data could be shared on a secure site that offers the ability to develop an integrated plan. 

Level 2: Basic Collaboration at a Distance

In this model, the behavioral health and the primary care clinic are still in separate locations. Both providers view each other as a resource and communicate as they need to on specific patients. The communication is driven by distinct issues. For example, a physician may request a psychiatric evaluation to determine if a patient has a specific psychiatric diagnosis. As information is shared, the diagnosis could be linked to an integrated plan that assists the patient with behavioral and primary care issues.

Co-Located Care

Level 3: Basic Collaborative Onsite

The behavioral health and primary care provider are located at the same site, but might not share the same practice space. Providers continue to use separate systems, but they do communicate on a more regular basis. The communication is by phone, email, and an occasional meeting to discuss patients they have in common. An electronic health record would pull all information about the patient into one location, making communication more accurate in its application to the patient’s treatment plan.

Level 4: Close Collaboration with Some System Integration

There is closer collaboration between the behavioral health clinician and the primary care provider. Both are in the same practice space and there is a beginning to integration of care by using some shared systems. The typical model would include a primary care provider that has a behavioral health staff member working in the practice. This type of collaboration is driven by complex patients with multiple health care and behavioral health issues. An electronic medical record would allow the behavioral health clinician to provide instant access to information the primary care physician needs, that would assist in the diagnosis and treatment of the patient.

Integrated Care

Level 5: Close Collaboration Approaching an Integrated Practice

There is a high level of integration between behavioral and primary care providers. The providers begin to function as a team, often having personal communication. The team works together to find solutions for treating more complex patients. Some of the barriers in this model are the lack of an integrated medical record and the need to change some of the structural issues integrating two different levels of care. Talking in the hallway is not an acceptable method for treating patients. The integrated electronic health record guarantees security and accuracy of the information. 

Level 6: Full Collaboration in a Transformed/Merged Practice

This model allows for the highest level of integration, which requires the largest amount of practice change. Full collaboration between primary and behavioral health practice allows for the treatment of the total person. Providers and patients view the process as one health system. The process of treating the whole person is applied to all patients, and not just targeted groups. Without an electronic medical record, this level of integration will not be achieved. The EHR must be able to accommodate the total person, not just the diagnosis.

Understanding the levels of integrated care is important in order to provide the best quality of care for your clients to ensure the best clinical outcomes for their total well being.