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February 2015 St@teside

Re-conceptualizing Integration: How to Build a Holistic Health System

On February 10, 2015, in conjunction with the National Health Policy Conference, AcademyHealth’s State Health Research and Policy Interest  Group (SHRP IG) held its annual Policy Breakfast. This year’s breakfast, "Re-conceptualizing Integration: How to Build a Holistic Health System," focused on the various levels of integration – from behavioral health and primary care integration to integration across the social determinants of health – that states are pursuing as they strive to transform their health care systems.

The first presenter, Charissa Fotinos of the Washington Health Care Authority, detailed Washington State’s behavioral health integration efforts. Washington has a multi-phase approach to integration, beginning with the integration of mental health and chemical dependency services and eventually moving to full behavioral health and primary care integration by 2020. The Authority has been tying in multiple strategies throughout the state in order to move toward full integration, including their home health program, State Innovation Model award, and local efforts to integrate behavioral health services into primary care settings. Washington has established a common measure set to assess performance as they move to full integration, which they will continue to update and refine. While spread statewide is still a few years away, some providers have become “early adopters.” These regional service areas have opted in to fully-integrated physical and behavioral healthcare purchasing in 2016.  

Susan Mathieu of the Colorado Department of Health Care Policy and Financing highlighted the state’s  Accountable Care Collaborative (ACC), which is supporting not only behavioral health integration, but also coordination with long-term services and support, public health, and other social services. The primary component of the ACC is Regional Care Collaborative Organizations (RCCOs), which are comprised of a network of primary care medical providers (PCMPs) who provide whole-person, coordinated care. The ACC allows for localized experimentation and innovation within the RCCOs, and has resulted in a wide-array of initiatives to foster coordination and integration with community resources. For example, one RCCO utilizes a data match with the sheriff’s department in order to support care for individuals while detained in jail and help provide a smooth transition for them back into the community. While such efforts are not always being implemented statewide, it is the ultimate goal of the ACC to foster the development and spread of the successful regional efforts out across the state.

Finally, Karen Minyard of the Georgia Health Policy Center highlighted the work of the Atlanta Regional Collaborative for Health Improvement (ARCHI). ARCHI has developed a collaborative, multi-pronged approach to address broader social determinants of health in the Atlanta metro region by restructuring care delivery and redistributing health dollars. Through the collaboration of local government officials, philanthropies, health care systems, public health authorities and others in the community, the collaborative has  developed a set of interventions, which are captured in the ARHCI playbook, to reduce the portion of population living under 200 percent of the federal poverty level, reduce non-urgent emergency department visits, and increase productivity by 2040, among other goals. While these transformation efforts have required initial upfront investments, they intend to recycle the subsequent savings in health care spending back into investments that will further promote population health. Dr. Minyard acknowledged that while these transformation efforts are happening at the local level, there’s an invaluable opportunity for the state to advance this work. State officials play a crucial role in generating the dialogue to get additional buy-in for these efforts, and the state also has an opportunity to put the necessary guidance and structures in place to support such local initiatives.

Dr. Fotinos, Ms. Mathieu, and Dr. Minyard’s presentations are available on the SHRP IG’s webpage. For more information on the SHRP IG or if you’d like to become a member, please email Becky Normile.