Integrating behavioral and physical health care has been shown to improve patient outcomes while also curbing costs. Unfortunately, though, achieving successful care integration is sometimes easier said than done. 

Achieving that success was the topic of a recent panel discussion at the 2020 Health Care Payment Learning & Action Network (LAN) Virtual Summit, held on Oct. 13. During the conversation, health care stakeholders who have been successful in their efforts shared their tricks of the trade. 

For providers just starting out on their integrated care journeys, commitment, quality measures and technology are key, the panelists said.

Victor Wu, the chief medical officer at TennCare, Tennessee’s Medicaid program, said successful care integration starts with patient, committed leadership.

“No matter if you’re a provider organization or state agency or you are a payer, there’s got to be some level of commitment at the organizational level to allow this to run out for several years,” Wu said during the panel discussion. “That ROI can’t just be [looked at] in one or two or three year chunks — it’s got to be a much longer view than that.”

In other words, change isn’t going to happen overnight. Neither are cost savings, as Wu has seen first-hand.

TennCare currently has two primary delivery system transformation efforts underway, Patient-Centered Medical Homes and Tennessee Health Link. Both aim to integrate behavioral and physical health for various different patient populations.

The programs have shared quality outcomes for mental and behavioral health organizations, who are provided with a tech tool that gives them access to comprehensive claims review, as well as real-time ADT data feeds from hospitals. 

When it comes to payment, Patient-Centered Medical Homes and Tennessee Health Link are moving incrementally away from fee-for-service and toward per-member per-month capitation payments and case rates to incentivize a holistic approach to care. 

While the programs have been successful, profitability has been a slow burn.

“There was no savings for the first couple of years,” Wu said. “We are only now in year three, and we’re seeing that we’re breaking even on that initial investment. … It’s not been ROI positive yet, but we believe strongly that it will get there in the long run.”

While patience is important, so are more concrete factors, such as quality measures, according to Judy Zerzan-Thul, chief medical officer at the Washington State Health Care Authority, which covers Medicaid, state employees, school teachers and retirees.

Specifically, she stressed the importance of the alignment of measures for all those parties working to integrate care.

“Alignment of … focused measures [can] help people get their arms around what’s the most important thing and how can I move that measure?” Zerzan-Thul said. “And then looking at how to do that in a team based way.”

Meanwhile, Greg Poulsen, senior vice president of policy at Intermountain Healthcare, praised the importance of technology.

While the health system first piloted a care integration initiative about 15 years ago, today telehealth has helped it drastically expand its integration efforts, allowing medical health care professionals to bring behavioral health experts into nearly every Intermountain exam room via technology. 

On top of that, payment is especially important, too, Poulsen said. 

“Technology today allows us with telehealth to do [care integration] vastly more efficiently and effectively than when we started to do it,” Poulsen said during the panel discussion. “I think the key is to get the payments so that you can bring those together and people can get appropriately compensated for it. With those two things together, I think it allows us to move forward effectively.”