“It has been defined in many ways, but in essence integrated health care is the systemic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems often occur at the same time. Integrating services to treat both will yield the best results, and be the most acceptable and effective approach for those being served. The question is not whether to integrate, but how.” – Hogg Foundation for Mental Health
So, what is a Health Home and how is it significant to today’s healthcare field. Often you will find a picture of a house used to describe the health home, but it is not a person’s residence where they receive services, rather it is a clinic where a person gets all of their physical and behavioral health needs met and/or coordinated in one place.
Health homes are not designed to treat acute medical problems; however, they are beneficial for managing chronic illnesses. This is unique characteristic of a health home as 75 percent of United States health care expense is for long-term care of chronic illness.
In addition to the delivery of primary care an integrated health home would provide:
- Access to and coordination of care: The health home coordinates all care for a patient and provides or assists with access to specialty care. One reason the United States has such expensive health care with relatively poor outcomes is because health care is rarely coordinated anywhere in our system.
- Adherence and compliance: The health home staff assists the patient in adhering to or complying with the recommendations of the provider. This includes a focus on ways to reduce complications for chronic illness and delay the advancement of the illness.
- Wellness: Many health problems are either caused or exacerbated by problematic lifestyle issues, such as poor diet and lack of exercise. The health home staff makes a special effort to encourage wellness activities.
Because so many clients with chronic mental illness view the mental health center as their primary place of care where they receive most of their treatment needs, support, etc., the concept of a health home was a natural fit for inclusion in the Affordable Care Act.
The Affordable Care Act grants states the opportunity to develop medical and/or behavioral health homes for Medicaid patients. The pursuit of these funds is through the filing of a “State Plan Amendment” (SPA). A state may apply for either type of health home and receive 90% of federal funding for the first eight quarters (two years). Missouri and Rhode Island have led the nation in the implementation of health homes. The key to a health homes success is improved access to health information across multiple service providers since it is impossible to coordinate health care without a full knowledge of all health services that a client is receiving (such as emergency room visits and hospitalizations).
The overarching goal for integrated physical health care and mental health care is to help patients with dependency problems and/or serious mental health issues live longer. People with chronic mental illness die 25 years earlier than their peers, principally from chronic physical health issues, not mental health problems. Likewise, there is substantial research demonstrating that persons with physical illnesses and co-morbid behavioral health problems often don’t improve physically unless the behavioral health issue is treated. A split has existed over several decades between behavioral health and physical health system delivery. Now, with the advancement of behavioral health home pilot project success, more systems of care are looking toward providing mental health care in coordination with physical health care. The startling numbers of adults with co-morbid physical and behavioral health conditions are 68 percent and likewise, 29 percent of persons with physical health conditions have mental health conditions.
“Lack of integration of care is a big problem throughout the US health care system. Poor care coordination leads to inferior outcomes. A study of the elderly found that 25 percentof Medicare patients have 5 or more chronic conditions, see 13 physicians and fill 50 prescriptions annually with little or no coordination.” – Christianson, The Innovators Prescription
The concept of the health home or patient-centered medical home is receiving wide attention from government-funded and commercial insurance. Centerstone Kentucky is conducting several projects to integrate behavioral and physical health care. For many years now, Centerstone has co-located in primary care settings to provide behavioral health supports. While this adds value to the clients we reach and to the staff at the health clinic, it is not a sustainable model to operate within our silos. Therefore, we are expanding our reach and beginning conversations to payors to begin the development of bundled value-based payment structures.
Ultimately, Centerstone would like to provide primary care on-site in our outpatient clinics. Given the stigma of mental illness that continues to linger in our society, we know those with serious mental illness prefer to be seen for all their needs in a clinic that is behavioral based.
–Kelley Gannon is COO of Centerstone.