Recently, a few behavioral health executives raised an alarm around the rising influence of healthcare integration on behavioral healthcare in the United States - and on addiction treatment organizations in particular. 

Their thinking goes like this: “As our field transitions more and more into the medical mainstream, addiction treatment organizations will be swallowed by larger healthcare organizations and addiction treatment centers will cease to exist as a separate entity.”

This cogent concern deserves thoughtful consideration, certainly. But how likely is it that integrated care will eventually pose an existential threat to the addiction treatment community as we now understand it?

Today, we’ll look at how the integrated care model is fairing today as well as what integration might hold for the future of the behavioral health community. 

What is Behavioral Health Integration or Integrated Addiction Treatment Care? 

Integrated healthcare refers to a model of care where providers of different types - PCPs, psychiatrists, therapists and behavioral health paraprofessionals, for example - coordinate to deliver holistic, patient-centered care. What this looks like on the ground is up for debate, but most agree that the level of coordination typically implied by “integrated care” is not the norm in today’s healthcare system. 

There are many words to refer to the concept of integrated care, and each has a slightly different connotation. You’ll hear integrated care, coordinated care, colocated care, collaborative care, care management, and system-level integration, as well as a number of other phrases when you overhear discussions about integrated care and related concepts.

What are Some of the Most Common Integrated Care Models for Addiction Treatment?

SBIRT - Screening, Brief Interview and Referral to Treatment 

Currently, most healthcare settings implement a weak version of integrated care, also known as coordinated care, technically called the “Screening, Brief Interview, and Referral to Treatment” (SBIRT) model. This is exactly what it sounds like: a primary care physician notices a patient is suffering from SUD and refers them to another provider or organization for behavioral healthcare. This “noticing” may be inefficient or non-existent, as many PCPs are not trained to identify or understand substance use disorders, and a disproportionate number of SUD patients do not have reliable access to healthcare services. The “referral” portion of a SBIRT intervention may also be lackluster, as many PCPs don’t have strong relationships with behavioral health providers and demand for behavioral healthcare outstrips capacity in nearly every portion of our country at present.

Colocation or Integrated Care Management 

This model places a primary care physician in close physical proximity to a behavioral health professional of some kind, often a Behavioral Health Care Manager. Other iterations of this model will put the physical health provider in the same building as the behavioral health team. The benefits of this model are obvious to those who are familiar with coordination of care issues that arise when behavioral health treatment is not embedded in physical health spaces. Whether it’s a dedicated liaison bridging the gap between colocation and SBIRT or a full-fledged “one stop shop” for both physical and behavioral health, this model has been shown to improve health outcomes for people with SUD. 

Truly Integrated Care 

Think of truly integrated care as a moving target, but the closest model we see in healthcare today is Medicaid Health Homes.  A unique not-for-profit called Intermountain Healthcare also operated on a more integrated basis than most organizations. These both have close care coordination across the physical-behavioral spectrum built into their operations at a core level. 

What Role Do Payers Play in Hampering Behavioral Health Integration? 

Payers have an outsized influence on the structure of how healthcare is delivered. The fee-for-service model disincentivizes integrated care because under a fee-for-service model, providers aren’t paid to coordinate care with other providers. Under fee-for-service, providers are paid a base amount whether coordination occurs or not. Of course, quality patient care is a natural driver behind getting providers to coordinate, but a system that doesn’t reward such behavior encourages a different focus. This also effectively means that collaborative care, under a fee-for-service model, is more expensive than uncooperative, siloed care. 

At the same time, under a value based care model - sometimes called measurement based care model - collaborative, integrated care becomes more affordable. This is because collaborative care is evidence-based and has been shown to improve health outcomes, particularly for high risk patients. Linking patient outcomes to financial reward throws the value of collaborative care into higher relief. Suddenly, collaborative care isn’t expensive. Under a value-based model, it’s just the most rewarding tool to get the job done. 

How Will Increasing Integration of Physical and Behavioral Health Care Affect the Addiction Treatment Community? 

Given the glacial pace of the United State’s incorporation of any integrated care model, It seems unlikely that integrated care poses any immediate threat to the addiction treatment community. That said, there are a few prudent takeaways here for behavioral health executives. 

They are: 

• If you haven’t already, begin preparing for the gradual transition to value based care (VBC). This means adopting an EHR or EMR that can handle outcomes measurements and the other specific data collection that goes into quantifying value under VBC.

• Ensure that your addiction treatment center software allows for ample interoperability so that coordination of care with providers outside your organization is smooth and intuitive. 

• Diversify the levels of care you offer in a single organization. Don’t just operate an Intensive Outpatient Program or a Residential program. Do both. Include medically supervised detox. Become the “one-stop-shop” in your community for people with SUD. Make a duplication of efforts elsewhere an exercise in futility. 

• If you want to see the SBRIT system to continue, hold up your end of the bargain. Keep networking fresh with your referral network. Expand your referral network. Offer value to referral partners to make the relationship mutually beneficial. Make referrals easy. Offer white glove service for new admits. Offer transportation coordination to and from care. Be sure your providers communicate early and often with the referring PCP, if applicable. Do everything you can to make sure referral partners are confident in sending your organization a steady stream of referrals. 

Behave Health: Tech for the Future of Addiction Treatment

Behave Health is committed to making it easier - and more profitable - to operate evidence-based, results-focused addiction treatment centers today and well into the future.

Our all-in-one app puts clinical, administration, staff, admissions, alumni, residents, treatment plans, billing, insurance authorizations and more - all at your fingertips.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

PS. Just getting started with behavioral health? Need help with certification, too? Behave Health can also help direct you to the right resources for help with licensing or accreditation by either The Joint Commission or CARF. Mention to your product specialist that you’re interested in this service after you start your free trial!