We are working on a public health project wherein three separate entities, two non-profits and one public health services provider, have come together to provide primary care, behavioral health/substance abuse, maternity and well-baby care, as well as dental services. Care delivery is conducted under one roof, but the entities remain separate otherwise (e.g., separate health records and accounting systems). We need to understand better how they are currently integrating care and how their efforts influence patients' experiences of care.
Ensuring that members of society are healthy and reaching their full potential requires the prevention of disease and injury; the promotion of health and well-being; the assurance of conditions in which people can be healthy; and the provision of timely, effective, and coordinated health care. A wide array of actors across the world including those in both primary care and public health contribute to one or more of these elements, but their work is often carried out in relative isolation. Achieving substantial and lasting improvements in population health will require a concerted effort from all of these entities, aligned with a common goal. The integration of primary care and public health could enhance the capacity of both sectors to carry out their respective missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population health.
When you say 'project' Suzanne - what do you mean? Is it funded? Has a community health assessment taken place i.e. PRECEDE-PROCEED? Is it research-driven i.e. perhaps an action research project? Difficult to answer without this type of broader context.
Yes, we are funded and are working collaboratively with the public health department and its partners at this center. This is an action research pilot project with an implementation science focus. We are implementing an organization development framework and assessing patients experiences of care to date.
What should we know about how public and / or community health entities integrate mental health and primary care?
The need to provide integral, personalized and personalized health care to patients requires the collaboration of different health and social entities (Socio-Health Care) and multidisciplinary teamwork to improve the Quality of Care and the sustainability of health systems.
The Substance Abuse and Mental Health Services Administration has assembled a good resource collection on this topic, if you haven't come across already:
https://www.samhsa.gov/children/behavioral-health-care-integration-resources
https://www.samhsa.gov/integrated-health-solutions/tools-resources
Thank you -- Yes, we are aware of the SAMHSA resources and are using those to define integration. Now, we are focused on implementation -- HOW others have achieved integration.
Suzanne,
I would like know to ask a few questions for clarity - are all care-seekers (in this case the consumer) under the same health financing scheme? If no, how many health insurers are providing care to clients? or there are both government (public) insurance and the private insurers (how many) and what are their terms of engagement and care coverage?
Without clear terms among the insurance companies, it may be challenging integrating the providers (as it's a determinant of the kind of services they would likely provide to beneficiaries).
Better still, care-seekers could have the choice between private health insurers and the government main insurance provider e.g. medicare (in Australia) or NHIS (Ghana), Then you could possibly have all insurers providing comprehensive set of health services to their clients, covering all essential aspects of their health care. Care-seekers would only pay a (fixed or regulated) premium augmented by the government premium which is more of a subsidy. This would ensure all residents would access the care.
Excellent questions, Joshua, and thank you for your thoughtful comments.
Yes, we are dealing with two public insurers at the national level. Then, we have state-level insurance, which is combined with one of the national insurers to cover low income families and individuals. The insurance scheme supporting our behavioral health population differs, at times, from the framework used to cover primary care (medical and dental services). It is more limited. Yet, both behavioral health and primary care providers accept a number of private insurance programs; hence, we have a payer mix of public and private insurers.
We have considered that we may need to focus on the population(s) that can navigate both systems (behavioral health and primary care) to achieve the highest level of integration. We may have lesser integration with those not covered under both schemes.
Another consideration is the level of mental illness, which can range from mild to severe. Because this project is limited to ambulatory care, we will likely further stratify our target populations to those independent enough to access outpatient services and live independently, or semi-independently.
Behavioral health is tied to incentives, public health is not. Under one roof they contradict each other.