KEY ACTIVITY #3:
Enhance Operational Integration of Behavioral Health
This key activity involves the following elements of person-centered population-based care: behavioral health integration.
Overview
Integrated care delivery needs a foundation of integrated operations, including practice management, scheduling appointments, teamwide access to patient data in the EHR, integrated consent forms, and more.
Integrated operations support the integration of care delivery with team access to departmental data and administrative support. A purposeful intent to integrate practice operations will avoid the pitfalls of separate, duplicative or insufficient operational infrastructures. Without sufficient operational integration, administrative and operational tasks often fall on BH clinicians, taking away from clinical time and potentially contributing to burnout, while clumsy integration may be experienced as disruptive or distracting by the care team and patients alike. Operational integration builds on the strengths and structure of existing operational resources, protocols, policies, workflows and practices.
Practices can mitigate individual case-by-case decisions, which leave more room for bias by integrating behavioral health operations and administration with existing structures, protocols, policies, workflows, support structures, and standardized decision-making. Without integrated operations, administrative and operational tasks can become unacknowledged and unpaid labor, often performed by lower wage staff.
When IBH is integrated operationally, building out social needs screening and response processes is straightforward and efficient. Many of the strategies listed in this section are applicable to integrating social needs care, such as integrated consents to treat.
Relevant health information technology (HIT) capabilities to support this activity include pre-visit planning tools; EHR documentation tools (e.g., templates and screeners); care guidelines; registries; care dashboards and reports, including behavioral health screenings and social needs data; quality reports; outreach; and care management and care coordination data. Tools needed for business intelligence include productivity and access data. See Appendix D: Guidance on Technological Interventions.
To enable team coordination, thought must be given to how to access relevant technology, how data capture can be distributed, consistent, and integrated into workflows, and how data is accessible across team members. Where possible, it is desirable to address the issue of siloing information in standalone applications with a goal of increased sharing of clinical diagnoses across the organization (e.g., BH and medical).
Action steps and roles
Suggested team member(s) responsible: CBHO, CMO, COO or clinic director, IT lead, QI lead.
Examples of operational integration methods include:
- Develop integrated forms: Implement a single consent to treat form and a single release of information form, both of which include all services offered at the organization. Given the differing legal and regulatory expectations between medical and behavioral health professions, this exercise requires modifications to existing forms, legal review, and retraining staff in information sharing practices. Example forms are provided in the resources section below.
- Integrate the electronic health record: Behavioral health providers must be considered full providers in the EHR system and be able to chart in an integrated health record with minimal firewalls or separate confidential tabs. BH diagnosis should populate within a shared problem or diagnosis list. Organizations should also have a behavioral health EHR trainer to support behavioral health providers.
- Integrate policies and procedures: All policies and procedures become integrated, addressing both medical and behavioral health. For example, procedures for urgent psychiatric situations can be added to those for urgent medical situations. Similarly, behavioral health protocols can be added to protocols for triage, referrals, and call center guidance scripts. New policies may need to be created, such as an integrated records policy and a policy to guide decisions on seeing employees as patients.
- Integrate administrative support: All administrative support provided to medical providers and teams is provided to behavioral health providers, typically proportional to the number of patient visits. This includes receptionist and call center support for scheduling or rescheduling; integration of behavioral health services into the organization's appointment reminder system and missed appointment follow-up system; proportionally equal access to language interpretation and translation services; support for copying, filing, filling out forms, and sending letters to and for patients; and equal assistance for referrals from the organization’s referral clerks or center.
- Represent behavioral health services in community-facing products: Behavioral health services are on the organization's website, printed marketing materials, community reports, posters, and other community-facing products. Behavioral health is also represented at community outreach events, such as health fairs. Within the organization, behavioral health providers are identified the same way medical providers are. For example, if medical providers have their names on the door or wall of the site and have business cards in the reception area, behavioral health providers have the same.
- Ensure parity of behavioral health treatment supplies: Behavioral health providers have a standard ordering process for their treatment supplies, just as medical providers have a standard ordering process for their equipment. The importance of supplies such as appropriate furniture and alternative lighting, as well as games for child patients or specific books for patients, are treated as equivalent to stethoscopes or exam tables for medical providers.
- Ensure QI and IT operational support for IBH: Just as it is done for the medical department, regular reports on productivity, cost, revenue and QI are run specifically for the IBH department.
- Support recruitment and retention: The organization’s human resources (HR) department provides support in developing job descriptions, recruitment postings, candidate selection, and hiring and retention. HR should have a behavioral health-informed hiring and selection process that is tailored to the specifics of practicing in an integrated setting.
Resources
AHRQ Integration Academy Playbook
Web-based comprehensive guide from the Agency for Healthcare Research and Quality (AHRQ) on behavioral health and primary care integration. Resources range from planning for integration, including creating a vision, preparing the infrastructure in your setting, and establishing protocols and clinical workflows to manage and treat your patients. The self-assessment checklist takes about 10 minutes and can be completed by members of the IBH team before, during or after implementation of integration strategies to assess the practice’s progress on integration.