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Integrated Care in Behavioral Health: Insights and Future Directions from the 2008 IBHP Convocation

This presentation by Frank deGruy at the 2008 IBHP Grantee Convocation explores the integration of behavioral health into primary care. It delves into definitions, historical context, methodological advancements, and lessons learned in addressing mental disorders and substance use problems. Key topics include the challenges in treatment adequacy, the significance of teamwork in care, economic analysis, and systemic issues within healthcare. The session emphasizes the importance of collaboration and innovative management strategies to improve patient outcomes in a fragmented healthcare environment.

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Integrated Care in Behavioral Health: Insights and Future Directions from the 2008 IBHP Convocation

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Presentation Transcript

  1. Integrated Care:Where’s this going? Why? IBHP Grantee Convocation Sacramento, CA September 12, 2008 Frank deGruy

  2. Definitions • Integrated • Combining dissimilar things into a coherent whole that has meaning and value • Behavioral Health • Mental disorders • Substance use problems • Health behavior change

  3. Where Did This Come From? • Mental Health Services Research • NIMH • AHRQ • RWJ • MacArthur • Substance Use and Criminality • Quality Improvement • Clinical Decisionmaking and EBM • PBRNs

  4. Progress In Methods, 1 • Basic Design Issues • Efficacy to effectiveness • Heterogeneous study samples • Usual Care control groups • Multilevel interventions • Multilevel and mixed methods evaluations • Stepped Care • Multistep interventions • QI “Research” • PBRN methods

  5. Progress In Methods, 2 • Economic analyses • Direct and Indirect Costs • Cost Offset • Cost Effectiveness • Cost Benefit • Chronic Disease Management • Registry • Self management • Care manager • Care protocol • Objective outcome measurement

  6. What Have We Learned? 1 • Prevalence and nature of the problems • Depression & impairment, then the others • Comorbidity • Adequacy of treatment • Health behavior change • Nature of primary care practices • Patients are reluctant to fragment care • Practices are overwhelmed: competing demands • Systemic nature of practice • Easier to change than to sustain

  7. What Have We Learned? 2 • Nature of the partners • Strange environment, different assumptions • Different work styles • Not used well • Teamwork: new layer of overhead • Nature of supporting systems • Commodification of clinicians and practices • Carveouts • More difficult to change • Different priorities, incentives (incentives!)

  8. The Medical Home • What is it? • Probable defining context • Behavioral/mental health integration at risk for marginalization • Mandate for MH resources to serve multiple purposes • Learn DM, Asthma, CAD literature • Comorbidity

  9. Today’s Problems • System Issues • Carveouts • Reimbursement rules & productivity incentives • Benefits design • How to deal with carveouts • Who pays for care managers? Specialty consultants? • Who “owns” them? Where do they live?

  10. Design Issues • Pilot Mentality • Running assessment • Midcourse corrections • Emphasis on teamwork • Vertical Integration

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