Behavioral Health Integration: Colorado Case Studies

Here at the Colorado Health Institute, we’ve been looking across the state to learn how some of our most innovative practices are going about integrating primary care and behavioral health.

The result of this analysis is a paper we are releasing today, New Models for Integrating Behavioral Health and Primary Care: Lessons from Six Colorado Health Care Providers.

We studied six practices that are testing an array of approaches. These clinics are spread across Colorado in both urban and rural areas. Some are privately funded while others are supported by public funding.

But they have at least two things in common. Each demonstrates how communities are developing local health care solutions to meet local needs. And each has lessons for Colorado’s policymakers, health care leaders and practices just beginning the integration journey.

I had the opportunity to talk with many people working to implement a more integrated model of care. They generously shared their time and expertise to explain successes and ongoing challenges.

While it is easy to get caught up in the technical details, I was struck by how personal this is.

Care providers and administrators alike passionately described seeing people in need of services that they were not getting, and how their overall health suffered. Sometimes the need was clear. Sometimes it surprised the providers.

In addition to better serving their patients, the providers told me they appreciate having a way to better collaborate with colleagues – both physical health and behavioral health providers who want to make sure patients get the care they need.

Based on our research and observations, CHI identified five critical success factors for moving toward a more integrated approach to providing physical and behavioral health care.

• Align the Level of Integration With Patient Needs and Practice Capacity. The complexity of patient needs drove the integration models we observed, ranging from primary care providers consulting with mental health professionals located in the same building to hiring mental health clinicians to join the practice.
• Innovate and Adapt Both the Workforce and the Workplace. We observed that new kinds of providers, or providers practicing in new ways, are the linchpin to effective integration.
• Create New Funding Models That Support Integration. The scale at which behavioral health care can be combined with primary care services will largely depend on how quickly payment models that can sustain integration are implemented.
• Recognize that Patient Numbers Impact Integration Potential. Patient volume drives decisions regarding the level of integration and the specialization of the integrated team, according to our observations.  A practice must care for enough patients to support the infrastructure and staff needed to provide the range of needed behavioral health and medical services.
• Lead Creatively and Learn Constantly. The leaders we observed are committed to the model, attentive to providing the resources and training to make it work, and willing to make mid-course corrections. Ongoing evaluation will be essential to better understand the clinical and business cases for integration. While necessary, it will be costly.

This analysis highlights critical questions that practices should ask as they decide on a care delivery model, identifies useful strategies for advancing integration and provides lessons from the field for providers and policymakers in a rapidly changing environment.

This is particularly relevant as Colorado works on its $65 million State Innovation Model (SIM) award focused on spurring the movement toward integrated physical and behavioral health care.

This is a first look at a quickly evolving field. Many of these models are new and evaluation is ongoing. CHI will continue to track progress, following up with the clinics profiled here to learn more about what is working well, and what remains a challenge.