Behavioral Health Integration Compendium

Curated Guidance and Resources from Experienced Organizations, developed with Chiron Strategy Group

Many health centers collaborate with external behavioral health providers or provide co-located or integrated behavioral health services within their health center. Some of the most significant challenges are determining which data to share, how to store it within the Electronic Health Record, and how to use it within primary care. This compendium of literature and resources offers some guidance related to behavioral health data integration, complete with key health center considerations for each.

Click on each heading below to access the original pieces being profiled.

Integrating Behavioral and Primary Care — Technology and Collaboration

• This article focuses on the challenges of integrating data between primary care and behavioral health. It discusses a number of concerns, and approaches that have been taken, including the benefits of developing structured data within the EHR.
• Health Center Takeaway: Patient consent for sharing sensitive health information can be integrated into the EHR, which will allow for greater information sharing while complying with Federal privacy expectations.

Can technology shape the future of behavioral health?

• This article includes a number of different ways that technology plays a part in integrated behavioral health, highlighting:
  • Adoption of telehealth as a means to augment care;
  • Inclusion of behavioral health data in Health Information Exchanges, citing the experience of Arizona; and
  • An example of an application being developed with NIH support that hopes to provide collaborative care tools to patients.
• Health Center Takeaway: Health centers are encouraged to investigate whether insurers will reimburse for telehealth and what is required to do so, to see if developing a telehealth program might augment the availability of behavioral health services for your patients. HITEQ has a number of resources related to telehealth.

Integrated Behavioral Health Partners Three Case Studies on Behavioral Health Data Sharing

• Three California case studies where organizations shared behavioral health data.  The website includes details regarding mental health data, substance use data, consent, methods of sharing, and challenges.
• Health Center Takeaway: Use these examples of different approaches to consent and level of information sharing to foster conversation among your leadership on how to create greater data integration.

Center for Health Care Strategies Integrating Physical and Behavioral Health Care in Medicaid Toolkit (Section IV: Information Exchange)

• CHCS has developed a rich resource for behavioral health integration.  This section focuses on information exchange, and has a number of helpful resources identified.
• Health Center Takeaway: The last two resources are integrated care plan templates; if you have an external behavioral health partner, consider how you might share data between the two organizations in a standardized format.

Patient-Centered Primary Care Institute Behavioral Health Integration: Obstacles & Successes

• Lessons learned from this interview:
  • Change the mindset from the bringing together of two services to truly integrating whole health
  • Shift from historic care delivery methods to a focus on achieving better health outcomes
  • Building trust with primary care providers is essential
• Health Center Takeaway: Determining what patients need will help guide the type of integration services your health center develops, which can include different approaches for different sites.

SAMHSA’s Quick Start Guide to Behavioral Health Integration for Safety-Net Primary Care Providers

• This guide helps any health center think about where it is in the process of integrating behavioral health, with a number of embedded links for additional information. Key areas of Administration, Workforce, and Clinical Practice.
• Health Center Takeaway: Use this guide to identify barriers to a fully-developed program, and find resources to help overcome them.

Zufall Health Center Integrated Behavioral Health and Primary Care Change Package

• Zufall Health Center partnered with a local behavioral health system to create an Integrated Behavioral Health system, using grant funding to help support the pilot. This collection of lessons learned focuses on:
  • Leadership Commitment
  • Clinical Information Systems and Measurable Improvement
  • Integrated Care Delivery
  • Clinical Decision Support
  • Patient/Family Engagement
• Health Center Takeaway: Leadership must assess organizational capacity to collaborate, and then collect baseline data on health outcomes, including preventative screenings, ED visits, hospitalizations as some of the early steps. Implementing measurement and management of key clinical outcomes are critical next steps.

NCQA Mainstreaming Behavioral Health Care

• NCQA has developed a Distinction in Behavioral Health Integration, which allows recognition of Patient Centered Medical Homes who have integrated care teams in place using evidence-based protocols and ongoing quality measurement and improvement.
• Health Center Takeaway: Many health centers have achieved recognition as a Patient Centered Medical Home (PCMH) or are along the way.  Aligning behavioral health integration work to earn this Distinction can help provide a roadmap for implementation of integration activities, and externally create validation for potential funders.

How Intermountain Healthcare's Mental Health Integration is Improving Care

• Intermountain Healthcare is a large health system, with 22 hospitals and 180 clinics. It has been developing Mental Health Integration services for a number of years.
  • They designed an operational system in which mental health specialists and nurse care managers are included in the primary care staff, through full-time co-location or frequent rotation.They evaluate the program regularly to monitor patient outcomes, team effectiveness and the culture of healthcare delivery from the perspective of the patient and the care provider.
• Health Center Takeaway: Integrating behavioral health takes time. Intermountain Healthcare has created an efficient process to develop programs and they plan for two years to implement and become revenue-neutral. Health centers would benefit from a long-term approach with a commitment of upfront internal or external funding.

Deeper Reading

If you are looking for more in-depth reading on the topic, visit the following links for longer articles.

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

• This Journal of the American Board of Family Medicine article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation.