Integrated Care

The Problem

Three Solutions

One Really Bad Solution

We Have Seen The Enemy

Collaborative Care Model

• Registry driven
• Medication and visit algorithms
• Disease focused
• Vertical integration model

SBIRT

• Universal screening
• Brief Intervention
• Registry
• Vertical integration model

Primary Care Behavioral Health

• Generalist (see all comers)
• Warm Handoff
• PCP as first customer
• Mirrors primary care style
• Horizontal model

Core Components of A Primary Care Consult

• Curbside consult
• Introduction
• Functional analysis
• Problem Formation/ Solving
• Planning
• Curbside consult

Different Than Co-Location

• No intakes
• No 50 min visits
• No reflexive weekly visits
• No caseload
• No solo practice

Not Different Techniques

• Motivational interviewing
• ACT, CBT
• Common factors
• Behavioral activation
• Sprinkled with the extra magic of primary care context

The Literature

• Effective, especially for depression
• Some evidence for cost-offset, sustainability
• Well tolerated/ liked by patients and medical providers
• Payment reform and workforce issues still stand in the way

The Business Case

• Cost offset through more appropriate utilization?
• Provider satisfaction
• Patient satisfaction
• Social gains (eg. employment)?
• Access to care

The Business Case: For You

• Job security
• Diversity of practice
• Unified funding bodes better for mental health
• Funner!

Barriers

A New Identity:
Grieving The Old Embracing The New

If It's Not For You...

• Can't avoid the (bio)psychosocial
• Effort to connect/ share records with PCPs
• Monitor medications more actively
• Develop awareness of medical factors
• Develop awareness of patient healthcare utilization
• Share risk with PCPs?

If It's Not For You...

• Collect outcome data regularly, registry
• Join cloud-based platforms to share data with primary care practices
• Use an enhanced medical screening form

coeintegratedcare.org
primarycareshrink.com
cfha.net