There is strong existing evidence to support the development of team-based care (i.e., “integrated care”) for behavioral health and primary care, although adoption is not yet widespread. Integrated care models may range from mental health care delivery becoming incorporated into primary care protocols, to the co-location of mental health specialists within primary care settings, to team approaches involving mental health providers lending expertise to primary care providers. Studies have shown that for integrated depression care to be effective, it must address comorbidities in addition to the depression itself. Fewer clinicians have been educated on integrated models of care and lack of funding for integrated care service, and there is a lack of financial incentive for development of integrated care systems. This qualitative study of 8 healthcare organizations summarize various of models of team-based care through the lens of workforce factors and characteristics.
Prior research has highlighted the benefits of integrated care, which contribute to better care for individuals, better health for populations, and lower costs for healthcare. Integrated care improves patient outcomes, reduces reimbursement issues, increases employee productivity, boosts employee satisfaction, and decreases costs. It also increases access to behavioral health services and reduces patients’ readmission rates. While the evidence supporting integrated primary and behavioral health care is strong and integrated care has been embraced by some care providers and health care administrators, the process of integrating care can nonetheless be challenging, specifically for members of the workforce. To understand the barriers, challenges, and best practices of integrating care, a case study was conducted with eight key informants from organizations throughout the country that have successfully implemented integrated care models.
The study participants described a diverse workforce population involved in integrated care, including a team of physicians, nurses, psychologists, social workers, licensed professional counselors, marriage and family therapists, and peer support personnel. Models of integrating care ranged from the infusion of behavioral health professionals into primary care settings to the integration of basic primary care services into behavioral health clinics.
Five themes related to barriers of integration and three areas of best practices emerged from our interviews. Participants identified the following barriers: 1) insufficient number of staff, 2) disagreements about provider roles, 3) restrictions on sharing patient information, specifically for patients receiving treatment for substance use, 4) state and federal policies that hinder reimbursement for care, and 5) workflow and logistical obstacles. Study participants identified areas of best practice as 1) building a culture of collaboration within the organization, 2) engaging employees in orientation or training programs, and 3) utilizing a cooperative approach and fostering a system for “warm hand-offs” to improve patient care.