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Integrating Care: Moving Beyond Interoperability to True Collaboration, Part I

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It’s something every traveler knows — you can’t get to where you want to be if you don’t know where you are. For the purposes of this blog series, our collective goal is to arrive at a place of integrated care where behavioral health and human services connect to acute and primary care, providing a single patient/provider view across the entire care continuum. We know we want to arrive at this place because we’ve seen the facts. Let’s refresh them now.

Severe mental illness (SMI) has a direct impact on lifespan. People with SMI live 13-30 years less than the average population. The irony? It’s primarily the result of physical illness. Approximately 34 million Americans (17 percent of the adult population) have comorbid medical conditions within a given year [source: The Synthesis Project].  Anxiety is often reported in those with cardiovascular disease, diabetes is common among those with depression, asthma and depression are also commonly reported, and the list goes on. Fragmented care fails to recognize that we’re dealing with a whole person. Fragmentation also increases healthcare costs. Behavioral health comorbidities are estimated to drive costs two to three times higher than just treating the medical condition.

So, where are we now? Behavioral health and human services are closing the gap with primary and acute care in technology adoption, digitization and interoperability. That means providers in those communities are beginning the journey to start exchanging data across systems, but there are still barriers that prevent holistic views of the individual at the point of care and limits the aggregation of data to provide longitudinal views as well as limiting the ability to track and report outcomes. Eighty-five percent of acute care providers currently use an electronic health record, 78 percent of primary care providers utilize an EHR, but only 50 percent of human services providers have such a system. The walls between many silos are still standing.

Value-based care models are being put in place to help us get where we want to be. These models come in different forms including accountable care organizations (ACOs) and the Certified Community Behavioral Health Clinic (CCBHC) pilot. The goal of these models is to reduce inpatient care and emergency room usage, drive consumer satisfaction, and improve both the value of services and overall population health.

We know where we are, we know where we want to be – but getting there isn’t easy. We have to build the vehicle to take us to the future. That’s what we’ll examine in our next post.

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