Title and Citation

Summary

Format

Behavioral Approaches to Chronic Disease in Adolescence: A Guide to Integrative Care

This resource offers clinicians an evidence-based guide to helping their young clients manage their chronic conditions and treating the psychosocial effects-from school problems and stigma to noncompliance and depression-that frequently follow diagnosis. Expert contributors present up-to-date information on epidemiology, symptoms, comorbid psychosocial problems, and treatment options for a variety of common illnesses, arranged to foster effective interventions for adolescents and efficient collaboration with other care providers in the team.

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Behavioral Health Integration: Blending Behaviorists into the Patient Centered Medical Home

This conference slide presentation stresses the imperative for integrating behavioral specialists into the PCMH model, distinguishing between true integration and mere co-location of services. The author describes the model presently in operation at Cherokee Health Systems in Knoxville, Tennessee.

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(900 KB)

Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home

The report unambiguously calls for the integration of behavior specialists into the PCMH, with particular attention to the IMPACT model, which emphasizes real-time collaborative care by a physician and a behavior specialist to deliver effective behavioral healthcare. The paper also identifies current systemic barriers (financing, regulation, privacy policies, and so on) that must be addressed to optimize the opportunity to realize meaningful patient and clinician outcomes. Copyrighted.

Web Access

Behavioral Integrative Care: Treatments That Work in the Primary Care Setting

Integrated care is one of the most important developments in the delivery of health care. In this practical volume, contributors address specific health problems that can be aided with integrated care to the benefit of the patient. Clinical psychologist and psychiatric social workers looking to expand their practice will find this volume of interest.

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Bellin's Total Health Model Improves Workforce Health and Reduces Costs

The Institute for Healthcare Improvement's Triple Aim Initiative has developed a report series to catalog Triple Aim model program progress. This overview describes Bellin Health in Wisconsin, which works with employers using an innovative framework it calls the Total Health Model.

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(340 KB)

Building Medical Homes: Lessons from Eight State with Emerging Programs

Eight states profiled in this report are at different stages in the development and implementation of PCMH programs and have relied on different strategies to encourage adoption of the model. Their experiences demonstrate that states can play a critical role in helping practices improve performance and can productively address systemic barriers such as those that can lead to conflict among payers.

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(550 KB)

Business Case for Bidirectional Integrated Care: Mental Health and Substance Use Services in Primary Care Settings and Primary Care Services in Specialty Mental Health and Substance Use Settings

Integration Policy Initiative participants recommended development of a business case for integration (with an emphasis on the SafetyNet system) while acknowledging the role of specialty services. This business case paper is intended for use by audiences who share the desire to simultaneously accomplish the three critical healthcare objectives of the Institute for Healthcare Improvement's Triple Aim, including decision- and policy-makers in the medical and behavioral health communities, health plan administrators, government, and advocacy groups.

Related reports of interest: The IPI Volume I: Report, issued in late 2009, and two volumes of additional materials, Volume II: Working Papers and Volume III: Examples for Dissemination, are available at the California Institute for Mental Health website

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(1 MB)

Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs

This white paper outlines methods and opportunities to better coordinate care with people with multiple health and social needs, and reviews ways that organizations have allocated resources to better meet the range of needs in this population. There is special emphasis on the experience of care coordination with populations of people experiencing homelessness.

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(510 KB)

Case Studies in Innovation: The Puget Sound Health Alliance

An overview of the community stakeholders and the 2003 state-of-the-healthcare-state in the King County, WA, is followed by an outline of the practice innovations that the Puget Sound Health Alliance implemented, which, the authors find, hold the potential to strengthen the health care system and provide hope that first-rate health care can be viable and sustainable.

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(140 KB)

Clinical Community Health Workers: Linchpin of the Medical Home

The emerging clinical community health worker model integrates community health workers as integral members of primary care teams inside a medical home. This evaluation documents the case management services provided by two clinical CHW programs at La Clínica del Cariño in Hood River, Oregon, and how they affected the care team's ability to deliver efficient, effective primary care. Clinical CHWs have the potential to make a significant impact on clinical efficiency and effectiveness as ambulatory primary care clinics strive to transform into high-quality, patient-centered medical homes and become linchpins in accountable care organizations. (Abstract only is in the public domain.)

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Cost and Quality Impact of Intermountain's Mental Health Integration Program

This review of Intermountain Healthcare in Utah focuses quality and safety as the practice network adopts principles of integrated care including patient and family involvement in care decisions, care coordination and community stewardship. Intermountain Healthcare has implemented a standardized clinical and operational team process that incorporates mental health as a complementary component of wellness and healing.

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(3.2 MB)

Developing the Medical Home in Primary Care: Using a Patient Navigator to Coordinate Care

Overlook Hospital Foundation funded a pilot project to demonstrate how patient navigators can help improve care coordination for patients of primary care practices. This is a report of the types of services the navigator provided, the barriers and facilitators to patient navigation in primary care practices, and understanding patients', physicians' and the navigator's perspectives and experiences with this service. (Online only.)

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Engaged Leadership: Transforming Safety Net Clinics into PCMHs (Implementation Guide)

SNMHI developed this implementation guide to help leaders drive and sustain PCMH transformation in their organizations. The guide uses the Institute for Healthcare Improvement's (IHI) Seven Leadership Leverage Points for Organization-Level Improvement in Health Care framework to explain the areas in which leaders can most effectively use their time and energies to drive and sustain transformation.

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(2.1 MB)

Evolving Models of Behavioral Integration in Primary Care

A primer on integrated care that includes both a description of the various models along the continuum and a useful planning guide for those seeking to successfully implement an integrated care model in their jurisdiction.

PDF
(650 KB)

From Striving to Thriving: Systems Thinking, Strategy, and the Performance of Safety Net Hospitals

Leading researchers explored the organizational characteristics of higher-performing Safety-net institutions. Strategic management, more so than structural characteristics, plays a critical role in thriving safety-net hospitals. Those that prosper have an understanding of the full spectrum of patient needs, seek partners to complement their operations, and limit services to those in which their organizations perform well. (Only the abstract is in the public domain.)

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Geisinger Health System: Achieving the Potential of System Integration Through Innovation, Leadership, Measurement, and Incentives

Pennsylvania's Geisinger Health System is a physician-led, non-profit integrated delivery system serving approximately 2.6 million. Geisinger's objectives are to simultaneously improve quality, satisfaction, and efficiency only by redesigning and reengineering the delivery of care. This philosophy is epitomized by ProvenCare, a portfolio of products for which care processes have been redesigned to reliably administer a coordinated bundle of evidence-based best practices. Use of the ProvenCare model has improved clinical outcomes while decreasing resource utilization.

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(1.4 MB)

Genesys HealthWorks Integrates Primary Care with Health Navigator to Improve Health, Reduce Costs

The Institute for Healthcare Improvement's Triple Aim Initiative has developed a report series to catalog Triple Aim model program progress. This overview describes Genesys HealthWorks in Michigan, which has focused on integrating care in primary care practices by adding health navigators to the care team.

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(440 KB)

Getting Started with Maryland's Patient Centered Medical Home Program

The objective of the Maryland Health Care Commission PCMH pilot program is to evaluate whether the PCMH model provides higher quality, more efficient care, and higher satisfaction for patients, nurse practitioners, and primary care physicians. The Pilot was designed to reward medical homes for the additional services, while creating a viable economic model for health care purchasers and maintaining administrative simplicity given multiple payers, diverse physician practices, and our desire to avoid risk selection against sicker patients.

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(700 KB)

HealthPartners Uses "BestCare" Practices to Improve Care and Outcomes, Reduce Costs

The Institute for Healthcare Improvement's Triple Aim Initiative has developed a report series to catalog Triple Aim model program progress. This overview describes HealthPartners Medical Group in Minnesota, which developed BestCare, a program that has institutionalized four key care principles: consistency, customization, convenience, and coordination.

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(350 KB)

Maximizing Team-Based Care in the Patient-Centered Medical Home

Implementing care teams is a critical element of transforming a practice into a patient-centered medical home. This guide presents a curriculum and provides training materials (PowerPoint presentations, handouts, skill assessments, exams, etc.) that practices can use to enhance the skills of Medical Assistants and Clinical Assistants.

PDF
(2 MB)

Promoting Recovery-Oriented Mental Health Services through a Peer Specialist Employer Learning Community

Many service providers are unsure of how to include peer specialists in their organizations and may be skeptical of their value. This case study describes an employer learning community model for providers and consumers to explore, through a team approach, the value of having consumers in peer specialist roles and the importance of recovery-oriented practice.

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QuadMed's Onsite Clinics Reduce Corporate Costs, Enhance Care

The Institute for Healthcare Improvement's Triple Aim Initiative has developed a report series to catalog Triple Aim model program progress. This overview describes QuadMed, which is based in Wisconsin, but whose innovative approach is to co-locate practices with businesses in four states in addition to Wisconsin.

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(360 KB)

Sentara Healthcare: Making Patient Safety an Enduring Organizational Value

Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the potential for patient harm. During the past five years, Sentara has intensified and expanded the program. The initiative has helped to reduce the measured rate of serious safety events at Sentara hospitals by 80 percent over seven years.

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(700 KB)

Triple AIM Journey: Improving Population Health and Patients' Experience of Care, While Reducing Costs

Case studies of three organizations participating in the Institute for Healthcare Improvement's Triple Aim initiative shed light on how they are partnering with provid¬ers and organizing care to improve the health of a population and patients' experience of care while lowering-or at least reducing the rate of increase in-the per capita cost of care.

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(600 KB)

Unique Model of the Community Health Worker: The MGH Chelsea Community Health Improvement Team

The role of the CHW is gaining much deserved attention. However, a system needs to be built for any CHW program to be successful and sustainable. This article describes a unique approach to community health work at the Massachusetts General Hospital Chelsea HealthCare Center, where a well-integrated CHW model provides support for patients, providers, the community at large, and the internal CHW staff. (Only the abstract is in the public domain.)

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Value of an Integrated Healthcare System: How MaineHealth Serves Its Communities, Members and Employees

MaineHealth is a non-profit integrated health system providing a range of care from prevention and health maintenance through tertiary services, rehabilitation, chronic care and long-term care. The health system serves three-quarters of the state's population. MaineHealth received funding from the Informed Medical Decisions Foundation to serve as a model program demonstration site for excellence in clinical care, patient safety, education and research.

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(2.3 MB)