Making Integration Work – ONEcare Population Health Academy

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

“Integrated care” models remain top of mind for executives of specialty and primary care organizations. There are some key questions that are part of every discussion: How can they make integrated care work for consumers? How can they develop a sustainable reimbursement model for integrated care? And how can they develop partnerships with payers that allow provider organizations to participate in the “value” they create.

From the payer perspective, there are models that fund integration at the plan level, like PACE programs and Medicare SNPs. The health plans managing these programs have moved ahead with a number of integrated care coordination models, targeted case rate payments, and subcapitation models to promote integration. Generally, executives of both payers and health plan organizations have found that these “integrated” models improve consumer health and decrease costs.

From the provider organization perspective, there are a variety of care delivery models that bring integration to the delivery system, from fully-integrated collaborative care to integrated primary care. But all of them bring challenges. The opportunities, the challenges, and solutions in integrated care was the focus of The 2022 OPEN MINDS Strategy & Innovation Institute session, Models For Integration Of Primary Care & Specialty Provider Organizations–Evaluating The Options, featuring Joseph Reis, ARNP, Medical Director for Peninsula Behavioral Health, and Tracy Rawls, Chief Executive Officer, Loree Elahee-Lee, Program Administrator, Primary Care, and Benedict Njoku, M.D., Prevention Project Director for eXclusive Services, as well as OPEN MINDS Senior Associate Ray Wolfe.

Peninsula Behavioral Health (PBH) is a non-profit provider organization in Port Angeles, Washington providing behavioral health, crisis intervention, and co-occurring substance use disorder services to adults, youth, and families. Last year, their team of 150+ provided care to over 3,000 neighbors, including almost 900 children. PBH has developed an integrated care model for consumers with serious mental illnesses. The model provides 150 consumers in the community with general primary care and prevention services, tobacco cessation, immunizations, and routine health screenings.

“We made the decision right from the start that we weren’t going to try to eat more than we could—we just wanted to start small in primary care”, said Dr. Reis. “The trick is getting started and finding a provider. I hired a great nurse practitioner who had been doing primary care for a long time and we started with limited services to build that practice out. We wanted to start small in order to build trust and skills and focus on those clients who are the most at risk.”

eXclusive Services serves the greater Cincinnati area with a community-based, medically-integrated program for consumers with addictions. They have developed services providing maternal opiate medical support and programs specific to methamphetamine addiction. Their treatment philosophy includes medical/primary care integration in their treatment models.

The eXclusive services team spoke to the need to change their organization’s structure and systems to add primary care. That evolution started with basing the primary care service on patients’ needs and integrating specialty clinical teams with their services.

While the models of the two organizations are quite different, the speakers identified common success factors. Those keys to success in adding primary care to a specialty care practice include building the right team, investing in the right technology, and diversifying reimbursement.

Build the right team: A big challenge for executive teams in moving to an integrated care model of any type is building the right team. Both specialty care and primary care clinicians need to move beyond their comfort zones in what they do and how they communicate. The right recruiting is the first step, and then it’s critical to build the right culture and communication model.

“To create a truly clinical and culturally integrated health program, you need to have the right people on the team,” said Dr. Njoku. “You need all the right players to represent diverse interests and opinions. You must have a strong leadership team, and a good source of information from the top down. Without that communication, you can’t do this. When you have an integrated program, there must be mutual understanding in terms of the vision and the goals you want to achieve, which is a patient-centered, one-stop shop.”

Ms. Elahee-Lee complemented that thought: “Make sure that your staff is properly trained,” she said. “Orient them to the proper procedures you want to follow and make sure you go over that on a regular basis so that it doesn’t get dropped. Everyone starts out gung-ho, but then things slide. Reinforce where they may need help, because staff must be comfortable asking for help when they need it.”

Invest in the right technology: A successful integrated care model runs on the right technology infrastructure, which is central to operational and service management. There are three elements to the right technology: a platform that supports care coordination, the ability to integrate consumer data from a variety of stakeholders, and the tools for population health management and value-based contracting.

“The information tech, and the electronic health record, is the most important thing,” said Dr. Njoku. “If you want an integrated health care model, all records must be connected. We are trying to put everything into one house. Before we had two different systems. Now we need to make sure we have the right technology to be able to do what we want to do across the board.”

Diversify reimbursement: Executive teams should look to diversifying health plan contracts and reimbursement models for their integrated care service models, like they would for any service. To be successful, the executive team needs to use the cost-of-service components and the performance metrics of the service models.

“Resources and funding are key,” said Ms. Elahee-Lee. “We have diversified streams of funding. You really need to look into how the systems will be funded across the board. Without that, you are setting yourself up to fail.”

It’s critical to address these issues, yet you must first evaluate and determine the optimum service line options for an integrated model. OPEN MINDS Senior Associate Ray Wolfe suggests beginning by using design thinking to create your model. “Define a profile of your average user or have focus groups of persons representing key demographics,” said Mr. Wolfe. “There are millions of concerns that will arise during integration, but most relate back to a single issue. We do not speak the same language or understand the business of the other. The pre-integration discussions should be very specific concerning administrative process and functions, and major corporate workflows such as reporting, hiring, firing, budgeting, and capital purchasing should be defined with accountable parties for each step in the flow. Clinical workflows, specifically around cross referral and treatment planning, should also be developed in objective discussion and communicated to staff.”

Of course, as Mr. Wolfe said, switching to an integrated care model involves many contingencies, with clear and precise communication being the key to achieving your organization’s goals. And when you use culture and technology as the guiding reference points, you will create a path for prolonged success.

For more on the integration model, check out these resources in The OPEN MINDS Industry Library:

And for even more, join me on February 16 in Clearwater, Florida for the keynote address by Rick Shrum, MBA, MHA Vice President & Chief Strategy Officer for WakeMed, “WakeMed’s Path To Value & Whole Person Care: The Development Of The WakeMed Behavioral Health Network”, which is part of The 2023 OPEN MINDS Performance Management Institute.