on 13 January 2014. In this article we provide 6 reasons for organising integrated care. Publishing the document is only the beginning for us, marking our ambition to support local areas to develop and implement integrated services that: Just before Christmas, NHS England and the LGA published the Better Care Fund guidance. Since the project began a high proportion of the participants have attended weight management classes or sought advice on how to stop falls at home. In my previous blog I talked about my vision for integration and the importance of putting people at the heart of care. A 2015 study by Anthem, for example, found the average medical cost associated with a disability claim was 25% ($8,000) less for members who engaged with a medical nurse care manager. For example, they may accompany a patient with a mental health … “Beating the Blues”, a program in the UK, has been shown to be evidence based and cost effective in treating anxiety and depression by the primary care provider. Examples of Integrated Care . Missouri: Community Mental Health Case Management (CMHCM) is a program that establishes a relationship between a case manager and a patient resulting in face-to-face assistance in a patient’s home or a community setting. Colorado: Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) is a project that brings together Rocky Mountain Health Plans, University of Colorado Denver Department of Family Medicine and the Collaborative Family Health Association. There is currently no standard description of integrated care and so this is interpreted in a particular clinical context or for a particular patient group. Also Acts, policies and procedures that underpin the development of integrated care and the organisations that are helping to make it happen. such as ‘integrated care pathways’, ‘patient-centred care’ and ‘shared decision-making’ are examples of attempts to align clinical, managerial and service user interests, and to improve coordination of care for patients, in particular those with long-term conditions. Better Practices in Collaborative Mental Health Care: An Analysis of the Evidence Base, a 2006 report by the Canadian Collaborative Mental Health Initiative. A number of case studies of good integrated health and social care. posted on Hundreds of healthcare providers are signing on to the Blueprint to learn about innovations, tools, clinical guidelines, and best practices to deliver effective, proactive care, and to involve patients in managing their own chronic conditions. Clinical pathways aim to promote … Primary Behavioral Health Integrated Care Training Acadademy, Harris County Community Behavioral Health Program, Improving Mood – Providing Access to Collaborative Treatment (IMPACT), "Integration of Mental Health/Substance Abuse and Primary Care. Prior to CMHCMs, per user per month costs rose an average of $750. More information on Missouri’s CMHCM model can be found here and the results of the most recent study can be found here. Measures of disparity between mental and physical health could also be used to understand integration between mental and physical health services. • The United States Department of Veterans Affairs is the largest integrated care delivery system in the US. Our Personalised Integrated Care programme brings together voluntary, health and care organisations in local areas to help older people who are living with long-term conditions and are at risk of recurring hospital admissions. A movement for change Problem statement. It also has a Primary Behavioral Health Integrated Care Training Acadademy, which provides education and training on their blended model of primary care and behavioral health services. https://publichealthmatters.blog.gov.uk/2014/01/13/finding-examples-of-good-integrated-care/. Integrated services that seek to provide the best care for patients - for example, by sharing patient information to improve handovers - will likely raise few competition concerns. To bring this to life we published Health and Care Integration – making the case from a public health perspective, … A really powerful area in moving forward in the health and social care field, and beyond too. However, there are many questions of detail, implementation and policy which are open for debate and often the ideas of personalization and integration take on a rhetorical value which … Peer support counselors are trained consumers of mental health care who come alongside patient to provide emotional and sometimes logistical support to ensure they stick with the plan of care. Thanks Sally for a really interesting and informative blog, with some great examples for other to look at too. Resources for integrated care . Integrated care: partnership working with the voluntary sector; Wakefield’s Fieldhead Hospital celebrates 200 year birthday – West Yorkshire STP; Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS; New virtual clinic designed by doctors gives renal patients more specialist consultant time ; Pain patients’ hospital wait reduced by 90% … For example, when Knappschaft, Bahn, See, a German payor and hospital system, decided to implement clinical pathways as a way to integrate care and thereby improve its quality and cost-efficiency, it focused first on getting physicians’ support by having them help develop the clinical pathways and on developing the IT infrastructure needed to support the pathways’ … Finding examples of good integrated care. Peer support is one example of community based support that has emerged as part of some integrated care efforts. Examples of integrated care for older people that have been subject to evaluation include the North American Programme for All-inclusive Care for the Elderly (PACE), Integrated Services for Frail Elders (SIPA) and PRISMA programmes in Quebec, and three European examples: Rovereto, Vittorio Veneto and Torbay. In my previous blog I talked about my vision for integration and the importance of putting people at the heart of care. PHE is committed to supporting local areas to develop and implement their integrated approaches. It combines the nursing care plan with the medical notes, providing a checklist of all actions and investigations and indication of patient's expected condition before discharge Washington: Improving Mood – Providing Access to Collaborative Treatment (IMPACT) is a team-based approach that integrates depression treatment into primary care and other medical settings. Psychiatry Online provides a 2008 study evaluating the program and found that this program resulted in a 12% improvement in symptoms of depression, self-harm, and alcohol or drug use. Inevitably, there will be enormous amounts of activity taking place locally as people share, refine and agree their integration plans. I’ll judge that Health and Care Integration – making the case from a public health perspective was successful if it helps local services make a real difference in their communities: if it has supported real change in thinking and in services. Theory & Practice Theory Concise snapshot of current priorities of team, across disciplines Intent is to better coordinate care among ALL providers Dynamic document –while overarching goals may persist, specific plans may change frequently … A 2008 report entitled From Fragmentation to Integration evaluates the ICARE Partnership North Carolina Project in order to compare outcomes before and after project implementation. The point on "ocus on people’s wants and needs rather than the organisations and structures that deliver care" is also extremely powerful. Minnesota: DIAMOND (Depression Improvement Across Minnesota Offering a New Direction) has made great strives towards improving healthcare for people with depression by changing the way care is delivered and how it is paid. If you have any information you would like to share, please do tell us about them in the comments. According to MCPAP's Fiscal Year 2012 Statewide Data study, successes in each of their distinct categories have increased as much as 57% since 2005. Practice examples of good practice in integrated care. More information on SHAPE’s efforts to implement payment reforms and strengthen the foundation for integrated care models can be found here. This paper proposes a set of key principles to underpin effective and sustained integrated care, and includes enabling strategies to drive reforms so that integrated care … The toolkit contains, among other things, a set 11 of case studies describing local examples of whole-system integration. Utah: Intermountain Healthcare is a non-profit health care system serving metropolitan Salt Lake City, which launched a project to integrate mental health care services into primary care practices. Doctors’ offices contend with a deluge of requests for the vaccine. They needed to adjust, for example, to working on interdisciplinary care teams and with support staff they have no authority over. Integrated care is not a new concept and arises from the consequences of fractures in systems and delivery that allow individuals to ‘fall through the gaps’ in care – e.g. Although it’s too early to measure outcomes, the health needs of residents are evident and the potential role the housing association can play in supporting residents to live hebalthier lives is clear. Case studies. The Integrated Behavioral Health Project (IBHP), Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE), The Massachusetts Child Psychiatry Access Project (MCPAP), MCPAP's Fiscal Year 2012 Statewide Data study, DIAMOND (Depression Improvement Across Minnesota Offering a New Direction), Institute for Clinical Systems Improvement, Community Mental Health Case Management (CMHCM). Study results can be found in an Unutzer et al article here and a Katon et al article here. The Local Government Association - with NHS England and ADASS, ADCS, Monitor, NHS Confederation and Department of Health - has developed an 'integrated care value case toolkit', which we hope will enable Health and Wellbeing Boards and local partners to understand the evidence and impact of different integrated care models on service users, as well as the associated impact on activity and cost to different parts of the health and care system. People benefit from care that is person-centred and co-ordinated within healthcare settings, across mental and physical health and across health and social care. Integrated Care Plans: Theory & Practice Jessie M. Gaeta, MD Boston Health Care for the Homeless Program May 2015. Read all the #PHEHealthMatters blogs here. This model of care was found to be more than twice as effective as usual care for depression, improve physical and social functioning of patients, improve patients’ quality of life, and reduce overall health care costs. A movement for change Designing Better Care for Malcolm and Barbara Frontier Economics (2012) Enablers and barriers to integrated care … Through the Institute for Clinical Systems Improvement (ICSI), medical groups, health plans, employers, and patients have collaborated to develop a better, evidenced-based model for managing depression. Example 3: Integrated Urgent Care Repeat Caller Document Set (POCD_MT200001GB02) with multiple payloads. The main aim of Australia’s National Primary Health Care Strategic Framework is to better integrate healthcare.1In order to improve efficiencies in primary healthcare delivery, sustainability and return on investment, and provide coordinated, patient-centred care, there is a need for integration across organisations and sectors in the health system. It’s important to maintain a clear line between the vision of an integrated system of care and the specific changes (outcome-based commissioning, accountable care, shared care planning, etc) that are seeking to achieve it. Recent policy and legislation, such as integrated care systems (ICS) and the Long Term Plan of the NHS (2019), have added topicality to this issue and the ability to deliver person-centred care. This older volunteer-led project, run by Community Service Volunteers (CSV) in partnership with the Brighton & Hove City Council Adult Social Care and Public Health teams and with Hanover Housing Association, aims to establish an integrated approach to maximising the health and wellbeing of older people. The success of this program has fostered implementation across the U.S. and is being replicated in Mississippi, Maine, New Hampshire, Oregon, and within local Utah state health agencies. It commissioned SCIE to create a series of local practice examples to shine a light on good practice in integrated care locally. SHAPE aims to understand the impact of global payment methods on the integration of behavioral health and primary care and test real world applications to inform policy. In a 2010 study, CMHCMs were instrumental in lowering health care costs. To bring this to life we published Health and Care Integration – making the case from a public health perspective, setting out why integrated public health interventions that prevent people from becoming unwell are central to improving outcomes. Note: The wrapped example is several "on the wire" payloads with the appropriate wrapper for the type of implementation. Integrated care systems are made up of three major pillars of work: primary care networks, personalised care and population health management. This white paper describes the characteristics of the integrated health care model, presents research about its current state of adoption and provides recommendations for overcoming barriers to … The project in North London is to determine whether housing interventions for older residents can reduce their use of NHS services. Examples of integrated care from around the UK are provided to illustrate how integrated care has been achieved. Definition and legislation of integrated care. For a more detailed analysis, please reference the 2010 IBHP Final Report. Integrated care … New data reveals how our diets are changing over time, Moving to Tier 3 - Escalating our fight against COVID-19, Lateral flow testing – new rapid tests to detect COVID-19. Posted by: Sally Warren, Posted on: 13 January 2014 - Categories: Reducing preventable deaths. As a policy and decision-maker it is therefore important to know the benefits. Tennessee: Cherokee Health Systems  has offered an array of comprehensive primary care, behavioral health, and prevention programs and services since the 1960s. We work with the organisations to co-design and co-produce an innovative combination of medical and non-medical support that draws out the … The need to address fragmentation in health systemsis increasing as more people live longer and with complex co-morbidities. Local PHE centres and Directors of Public Health in local authorities can play a strong role in helping shape and move forward the integration plans, which are due to be submitted next month . The Better Care Support Team (BCST) oversees the aims and objectives of the Better Care Fund (BCF). IBHP-funded projects have showed statistically significant improvements in patient physical, mental, and general health, and primary care providers reported a lower level of integration between physical and behavioral health at the clinic. In addition, patients treated in the Integrated clinics had a 27% lower rate of cost growth. Comment by Texas: Harris County Community Behavioral Health Program is an integrated care program operating in community health centers serving low-income uninsured residents in Houston, Texas. The key being to understand the people and communities wants and needs! Kristian Hibberd (Comms Manager, LGA) There are international examples where care has been ‘integrated’ across traditional service boundaries so that primary and secondary care can be delivered to patients with complex needs in a more efficient and convenient way. LifeLines volunteers run free health and wellbeing activities for residents in the extra care housing scheme, offering support to those who would like more social interaction or help to attend medical appointments. Health and Care Integration – making the case from a public health perspective, Flooding and the public's health: looking beyond the short-term, Understanding alcohol-related hospital admissions. For a more detailed analysis, ple… Find out how local partnerships across the country are adapting to meet the health needs of their populations. Jewel Edwards-Ashman: To explain some of the benefits of working in integrated primary care, Dr. Goodie and Dr. Hunter often use the example of patients visiting their primary care physicians for common medical problems, and then sometimes being referred to … Initial projections indicate potential savings of $656 Million on a population of one million patients who have conditions like arthritis, asthma, diabetes or hypertension in conjunction with a behavioral health condition. According to the study, the physicians identified three primary skills needed to succeed in an integrated care model: Orienting to teams and systems. Integrated care requires a different way of organising care, for example, cross-organisational collaboration. ", Better Practices in Collaborative Mental Health Care: An Analysis of the Evidence Base, White Fragility: Why It’s So Hard For White People To Talk About Racism, Toolkit for Teaching About Racism in the Context of Persistent Health and Healthcare Disparities, UCLA Latino Policy and Politics Initiative. Research on the CMHCM model is beginning to show positive results. In … Case studies of these pioneering programs can be found in the Agency for Healthcare Research & Quality's (AHRQ) 2008 EPC report, "Integration of Mental Health/Substance Abuse and Primary Care. Stay up-to-date with the latest medical home news, Addressing Social Determinants of Health in the Time of COVID, January 2021 webinar: The State of Primary Care Spending, Medical Director Leadership Institute (session 2), Copyright © 2020 Primary Care Collaborative, Primary Care Investment: Lessons Learned from Multi-Stakeholder Advisory Groups, Innovations in Oral Health and Primary Care Integration: Alignment with the Shared Principles, Primary Care Spending: High Stakes, Low Investment, 'You Can't Treat If You Can't Empathize': Black Doctors Tackle Vaccine Hesitancy. Example of page from an integrated care pathway for cardiac catheterisation. Beating the Blues® is the only computerized cognitive behavioral therapy (CCBT) program approved by NICE for treatment of depression. the development and impact of integrated care to date, homes in on some examples of successful practice and draws out the key lessons for later-adopters. To illustrate who integrated care is for, the following slides look at some key care groups to whom integrated care is most suitable. California: The Integrated Behavioral Health Project (IBHP) is an initiative launched in 2006 to accelerate the integration of behavioral health services into primary care settings in California. There are several examples of integrated programs from across the country. We have since been contacted by colleagues keen to share further examples of innovative work. Try not to think of integrated care as a ‘thing’ and more as a state. Tags: integrated care, integration, Integration Pioneers, patients, public health, Public Health England, Comment by One such example is the implementation of integrated care for Type 2 Diabetes in the Netherlands, a model that was recently subject to a case study under the EU-funded Project INTEGRATE. I have no doubt that there are many more innovative projects taking place across the country. posted on Although excellent examples of integrated care can be seen in Australia and New Zealand, these often work despite the system, and are not able to be more widely translated into the broader system as normal and best practice. California: The Integrated Behavioral Health Project (IBHP) is an initiative launched in 2006 to accelerate the integration of behavioral health services into primary care settings in California. Information, commentary and tools for local teams as they … The official blog of Public Health England, providing expert insight on the organisation's work and all aspects of public health. Results of this model can be found here. on 20 January 2014. Patients with depression treated in these integration clinics were found to be 54% less likely to visit the Emergency Department. In an attempt to bring our ambition for integration to life, Making the case brought together a number of examples of innovative work already underway from across the country. N/A: ITK: N/A: N/A: Integrated Urgent Care Ambulance Request (REPC_MT200001GB02) Payload Wrapped Payload Templated Payload Rendered Payload; Example 1: Integrated … For example, we have tested the feasibility of a range of measures to assess aspects of integrated care at GP practice level, and identified potential measures and data sources. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes. What we mean by integrated care; past developments in integration; current practice and how we can make it work in the future. A clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is one of the main tools used to manage the quality in healthcare concerning the standardisation of care processes. For example, Minnesota’s Integrated Health Partnership’s ACO model includes a virtual model enabling providers not affiliated with a hospital or IDS to form virtual networks for the purposes of serving as a Medicaid ACO [ 21 ]. T The core of the Dutch model are so-called “care groups”, legal entities that act as intermediaries between health insurers and healthcare professionals. Independent evaluation showed that 78% of beneficiaries and 71% of volunteers feel less isolated, while 93% of volunteers and 82% of beneficiaries made new friends. primary/secondary care, health/social care, mental/physical health care. IBHP-funded projects have showed statistically significant improvements in patient physical, mental, and general health, and primary care providers reported a lower level of integration between physical and behavioral health at the clinic. ", Information on Integrated Care from the American Psychiatric Association. We identify factors likely to facilitate success – engaged leadership at all levels, real team working, a clear grasp of local population needs, underpinned by the appropriate tools and technology, continuous learning … Have you seen #PHEHealthMatters, a resource for professionals providing data, tools and interventions to help you tackle key public health issues. North Carolina: ICARE Partnership North Carolina Project seeks to increase access to quality, evidence-based behavioral healthcare services for North Carolinians. A number of things can be done to create an integrated system of care, however what those … Massachusetts: The Massachusetts Child Psychiatry Access Project (MCPAP) is an interdisciplinary healthcare initiative that assists primary care providers (PCPs) who treat children and adolescents for psychiatric conditions. An interim report identified that 92% of the participants had one or more long-term health condition, 49% felt lonely at least some of the time and 25% had suffered a fall in the last six months. Over the coming weeks, through our centres, we will support local areas by sharing information and learning about integrated public health interventions, and we will continue to work closely with our national partners, to support the integration pioneers as the implement their innovative approaches and share lessons learnt. Bren Older volunteers run activities for their peers, ranging from art to reading, yoga and dancing. More about this blog. Since implementation, these costs are falling by an average of $500. The two most fundamental of these include: first, the recognition that engaging and empowering people and communities should be a central component to any integrated care strategy; and second, that integrated care strategies might be most powerful where they become population-oriented and focused on promoting health, for example by bringing together health and social care with other players such as housing, schools, community groups… I was really interested to hear about the Health Begins at Home project Family Mosaic, one of the largest housing providers in London and the South East, is taking forward in partnership with the London School of Economics and their local health partners. The health system incorporates multiple levels: Meso-level integration, the focus of this paper, thus rests on the abi… Key principles of integrating care: evidence, lessons and examples from around the world Dr Viktoria Stein Head of the Integrated Care Academy© International Foundation for Integrated Care. I was also interested to hear about LifeLines. 86% of beneficiaries and 83% of volunteers agree that they receive health benefits. Vermont: Vermont Blueprint for Health is a new way of looking at the practice of medicine and chronic care.