As healthcare providers search for better ways to optimize patient outcomes, the integrated care model has emerged as a highly beneficial method of enhancing coordination and communication among patients and healthcare workers.

Unlike traditional delivery systems, integrated care combines psychiatric care with primary or specialty services, such as oncology or women’s health, in one central location.

Joseph R, Kester R, O'Brien C, et al. The evolving practice of psychiatry in the era of integrated care. Psychosomatics. 2017;58(5):466–473.

 

This approach, especially for those with severe or persistent mental illness, may help improve the overall physical health of patients who don’t seek treatment elsewhere.

More agencies have committed to implementing integrated healthcare delivery models in clinics around the country. Therefore, it’s essential that behavioral health providers understand how the model benefits patients and impacts public health.

 

The case for integrated care

Mental illness and substance use are prevalent in the US—about 50% of its population struggles with these issues. It’s been estimated that about half of those affected received care from a behavioral health provider, while the other half saw primary care providers.

The stigma surrounding mental health care, together with lack of access (in part to provider shortages) and the underdiagnosis of mental health disorders by general practitioners, may drive some patients away from much-needed specialty mental health care.

Other research confirms this finding, including a 2015 study that found only about 20% of adults with mental health issues receive treatment from mental or behavioral health specialists.

Norfleet KR, Ratzliff ADH, Chan YF, et al. The role of the integrated care psychiatrist in community settings: a survey of psychiatrists’ perspectives. PS. 2016;67(3):346–349.

 

However, integrating mental health services into other types of practice has been shown to:

Integrated health care. American Psychological Association. 2013.

 

• Boost the quality of care provided

• Improve access to mental health services

• Lower total healthcare costs for the patient and the healthcare system

• Reduce symptoms of mental health problems, such as depression

 

Different care models

According to the Substance Abuse and Mental Health Services Administration, integrated healthcare may be categorized in the following three ways:

Coordinating care for better mental, substance-use, and general health. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. National Academies Press (US); 2006.

 

• Integrated program: This type of organizational structure addresses all of the patient’s needs by ensuring they’re connected with appropriate staff members or linked with other programs.

• Integrated system: This structure uses funding, credentialing/licensing, needs assessment, data collection/reporting, planning, and other systemic and operational functions to support a variety of programs for patients with different needs.

• Integrated treatment: This refers to the interactions and work occurring between behavioral health providers and other clinicians to address the individual and varied needs of each patient.

 

Implementing integrated care

The successful implementation of integrated care models into practice requires adherence to several key components, including:

• Formation of a multidisciplinary care team

• Screening, evaluation, and referral to integrated care

• Decision-making support for care that is stepped and measurement-based

• Exchange and tracking of information among care providers

• Links with social services and other community resources

• Self-management support that is culturally adapted

• Quality improvement across the entire system

A 2020 survey of providers by the Commonwealth Fund identified internal and external barriers to integrated care.

Docherty M, Spaeth-Rublee B, Scharf D, et al. How practices can advance the implementation of integrated care in the covid-19 era. The Commonwealth Fund. November 17, 2020.

These included regulatory or policy-related barriers, as well as barriers caused by organizational structures and facility processes.

 

Such barriers may include insufficient health IT infrastructure, low buy-in from primary care providers, lack of reimbursement, and insufficient physical space for providing healthcare services.

As agencies like the Centers for Medicare and Medicaid continue to introduce billing and reimbursement options supporting integrated care, clinicians should expect the trend toward this care model to continue, ideally leading to an overall improvement in public health.