Integrated Care
The future of healthcare lies in the systemic integration of physical healthcare, behavioral healthcare and other factors that influence an individuals’ health. Integrated care produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.
Integrated care providers offer behavioral health services from a primary care setting or a fully functional primary care clinic as part of a behavioral health setting. This typically involves a primary care physician employing a licensed behavioral health practitioner to provide outpatient treatment to individuals being served by the primary care physician.
Integrated care can also be provided by incorporating primary physical healthcare services into a behavioral health setting. Practice settings could include Federally Qualified Health Centers (FQHCs), rural health centers, county health departments, hospital outpatient practices, behavioral health or intellectual and/or developmental disability provider agencies and general primary care practices.
Vaya requires network providers to collaborate with all healthcare providers engaged in a member’s care and to orient assessments and referrals to meet the needs of the whole person. As we move forward toward integrated care, it’s important that network providers develop relationships across the service system and learn more about treating individuals with co-occurring behavioral and physical health needs.
To learn more, visit the Center of Excellence for Integrated Health Solutions, a project of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA).
What is integrated care?
Integrated care is the coordination of general and specialty healthcare, which refers to mental health, substance use disorder and intellectual/developmental disability services.
Fragmented, or “siloed,” care is reactive, rather than preventive, meaning members are only seen when they seek treatment. This leads to duplicative care, higher costs and worse outcomes for members. An integrated care plan reduces the siloes between specialty and physical healthcare. From research, we know that receiving care in a team-based setting where medical providers work hand-in-hand with specialty care professionals results in higher screening rates, more proactive treatment and better clinical outcomes for complex chronic diseases.
Before integrated care
A fragmented care system is often full of administrative barriers. For instance, care coordinators frequently complete release forms for each care team member, often travelling multiple times for member signatures on various documents. Under this model, care coordinators also have the time-consuming responsibility of delivering forms, care plans and other materials to primary care physicians for processing. Often, care coordinators must repeatedly follow up with physicians to ensure they have received the proper documentation and that necessary forms have been processed.
After integrated care
Administrative tasks are streamlined through automated processes in an integrated care model, reducing costly data entry errors and saving valuable time for care coordinators and members alike. Care coordinators only complete one release form, and primary care physicians are notified of the request. Responding to the request is automatically integrated into the physician’s workflow, helping ensure quick response times and better engagement between Care coordinators and physicians.
Physicians are able to upload the necessary information into a shared system to which coordinators have real-time access. In addition, care coordinators and all care team members are able to easily connect through Vaya’s Incedo platform, giving the entire team an open line of communication to better coordinate for the benefit of members throughout their managed care journey.
What is complex care management?
Complex care management enhances traditional models of care coordination. It equips members and care teams with the resources they need to achieve better, more sustainable health outcomes. Member needs are addressed more effectively and more efficiently, moving us closer to achieving the Quadruple Aim of Healthcare:
- Enhancing the member experience: We strive to ensure that our members are connected to the right services and are satisfied with the care that they receive.
- Improving population health: We empower our partners to address the behavioral health, medical and social concerns affecting members’ health outcomes.
- Improving the work-life balance of healthcare providers: Our care coordinators work alongside providers so they have the tools, information and resources they need to assist our members.
- Reducing health expenditures: Our members are connected to the right care to reduce costly hospitalizations and promote overall health.
