Tuesday, May 4, 2010

[EQ] Evolving Models of Behavioral Health Integration in Primary Care

Evolving Models of Behavioral Health Integration in Primary Care

Chris Collins, Denise Levis Hewson, Richard Munger, and Torlen Wade
The Milbank Memorial Fund - May 2010

The report is available for free online at
PDF file [102p.] at:

“…..This report offers an approach to meeting the unmet needs of the millions of Americans suffering from mental illness and substance abuse: the integration of primary care and behavioral health care.

The report summarizes the available evidence and states’ experiences around integration as a means for delivering quality, effective physical and mental health care. For those interested in integrating care, it provides eight models that represent qualitatively different ways of integrating/coordinating care across a continuum—from minimal collaboration to partial integration to full integration—according to stakeholder needs, resources, and practice patterns

This report also provides an orientation to the field and, hopefully, a compelling case for integrated or collaborative care. It provides a concise summary of the various models and concepts and describes, in further detail, eight models that represent qualitatively different ways of integrating and coordinating care across a continuum—from minimal collaboration to partial integration to full integration. Each model is defined and includes examples and successes, any evidence-based research, and potential implementation and financial considerations.

Also provided is guidance in choosing a model as well as specific information on how a state or jurisdiction could approach integrated care through steps or tiers. Issues such as model complexity and cost are provided to assist planners in assessing integration opportunities based on available resources and funding. The report culminates with specific recommendations on how to support the successful development of integrated care. ….”

Table of Contents

Executive Summary
Introduction—Making the Case for Integrated Care
Orientation to the Field
Information Technology
Practice Models of Integration
Practice Model 1: Improving Collaboration between Separate Providers
Practice Model 2: Medical-Provided Behavioral Health Care
Practice Model 3: Co-location
Practice Model 4: Disease Management
Practice Model 5: Reverse Co-location
Practice Model 6: Unified Primary Care and Behavioral Health
Practice Model 7: Primary Care Behavioral Health
Practice Model 8: Collaborative System of Care
Considerations for Choosing a Model
Incremental Steps in a Challenging Fiscal Environment
Recommendations for Health Care Delivery System Redesign to Support Integrated Care
Resources  -- References

List of Tables

Table 1: Four Quadrants of Clinical Integration Based on Patient Needs
Table 2: Using Information Technology to Integrate Care
Table 3: Collaborative Care Categorizations at a Glance
Table 4: Examples of Practice Model 1—Improving Collaboration between Separate Providers
Table 5: Examples of Practice Model 2—Medical-Provided Behavioral Health Care
Table 6: Examples of Practice Model 3—Co-location
Table 7: Examples of Practice Model 4—Disease Management
Table 8: Examples of Practice Model 5—Reverse Co-location
Table 9: Examples of Practice Model 6—Unified Primary Care and Behavioral Health
Table 10: Examples of Practice Model 7—Primary Care Behavioral Health
Table 11: Examples of Practice Model 8—Collaborative System of Care
Table 12: Summary of Primary Care–Behavioral Health Integration Models
Table 13: Incremental Steps for Integrating Care

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