"Integrated care" pops up a lot these days during health care discussions. But the landscape for collaborative care and integrated service delivery system models is evolving. With all the discussion of integration, a key question is how an integrated model is defined.

Here are the four models we should be aware of:

Collaboration between separate providers - Providers using this model develop either formal or informal agreements as to how they will operate to provide both physical and behavioral health services. One requirement for this to work is that there's full disclosure of services provided to the client. Within this model, the providers may both use different tracking systems and work with multiple payers for processing claims. A drawback to this model is that it remains more provider-centered as opposed to client-centered

Co-location - Many integration projects begin with a co-location model, where mental health professionals and primary care providers practice at the same site, building or office. This is beneficial as patients do not need to travel to multiple locations for services. With this type of arrangement, there's typically more information sharing among the providers and an opportunity to provide a warm hand-off for the client. Primary care providers have found that patients who receive referrals to mental health providers are less likely to follow-through with a visit when in a separate facility. One drawback is that co-located practitioners may lack the time, operational support, and motivation to work collaboratively to consult about patient care

Consultant model - In the consultant model, a mental health professional is a member of the primary care team at the same work site and follows a schedule that can mimic the primary care model, including brief interventions and consultations. This model emulates the Federally Qualified Health Center (FQHC) model and allows the patient access to a behavioral health professional typically on the same day as a physical provider. Sometimes the interactions with the mental health professional can be shorter and may also result in referrals to deal with some of the more complex issues around behavioral health. 

Fully integrated - In this model, the client benefits from a one-stop shop for addressing both physical and mental health needs. All providers are within one group which allows the center to manage from one integrated health record and generate one bill for providing services. In this model, effective case care coordination becomes the norm as the primary care physician and behavioral health practitioner work together to create a treatment plan. As patients work through chronic conditions and other physical ailments, they also have greater access to working with someone to deal with any behavioral problems, resulting in a much more structured and monitored effort.

Thank you to the editors of Open Minds for these descriptions.

In looking ahead to the challenge of making integrated models produce good outcomes and achieve efficiency, definition is key.

-- Bettie Reinhardt, MPH

NAMI California Legislative & Public Policy Consultant

Bettie.reinhardt@namicalifornia.org  

Although Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted over four years ago, a final rule implementing the law has not yet been issued. In January, President Obama pledged to publish final regulations in the near future. In the interim, individuals and families seeking care for serious mental illness have been unable to access the health care services they need.

Until final parity regulations are issued, it is important that the federal agencies charged with enforcement of parity protections hear from persons with mental illness and family members about their experience in confronting ongoing practices in health insurance and limitations that apply only to mental health benefits that are likely violations of MHPAEA - and will clearly be prohibited in the final rule. Parity violations include plans more strictly managing or denying mental illness treatment services more than other services covered by the plan. More information may be found at: http://parityispersonal.org/.

Your Requested Action:
Persons with mental illness and family members are urged to email parity violation stories to both the Departments of Labor and Health and Human Services. NAMI encourages stories to be reported by both persons with mental illness and families that are still struggling to access non-discriminatory coverage for mental illness treatment services. Be sure to tell your personal story and attach any relevant documents (if available) such as a denial letter, summary of benefits or other materials provided by the health plan.

View the details on reporting stories and where to send comments.

NAMI California is now accepting applications for our Ending the Silence (ETS) Presenter Trainings!

Are you interested in making a difference in the lives of young people? Do you have a passion for reducing stigma and discrimination toward people with a diagnosable mental health condition through education? If so, join enthusiastic people across the state in participating in the Ending the Silence program!

ETS is a program designed for high school audiences and gives students an opportunity to learn about mental illness through an informative PowerPoint, short videos, and personal testimony. Through the presentation, students learn symptoms, and indicators of mental illness, and are given ideas about how to help themselves or others who may be in need of support.

NAMI California is looking for presenters who are comfortable with self-disclosure, knowledgeable about the various disorders, and young adults with a diagnosable mental health condition who are doing well in their recovery. Since this program will be reaching out to high school students, we are especially interested in getting young people (ages 18-29) involved in this program. Two-hour webinar trainings will be held on April 2, April 30, June 12 and June 27.

If interested, please complete the application and email/fax to Beth Larkins, NAMI California Program Coordinator, 916-567-0163 (phone) or 916-567-1757 (fax).