Integrated Care: The Challenges of Harmonizing Physical & Behavioral Health Treatment

April 26, 2018

As consultants, it is our job to sleuth out the underlying problems and find creative ways to marry healthcare and technology that not only feel natural for our clients, but also adhere to the marathon list of regulations and guidelines for our industry.

As companies embrace electronic healthcare record (EHR) systems and work tirelessly to find the best solutions to implementing them in both physical and behavioral health settings, we are seeing a specific set of challenges emerge.

Communication Regulation

Picture this:

A psychiatrist sits down with a patient and discovers that the patient is showing symptoms of a liver condition. She knows the patient needs to see a medical doctor but she hesitates wondering, “How do I communicate this?”

In the world of integrated health care, if an event or communication is not documented in the patients record, it did not happen. For centuries, we relied on paper for record-keeping. Now, in the digital age, we have gone electronic with our documentation.

While EHRs are to the benefit of patients, healthcare systems, and networks who struggle to share information securely across great distances and specialties they can be difficult to work with on the ground floor.

This psychiatrist would likely find it easier to walk down the hall or to the opposite wing of the facility and speak directly with the physician in charge of this patient’s physical care. Or she may be inclined to pick up the phone and dial a quick extension. However, thanks to overarching regulatory guidelines and healthcare plan requirements, the new world of integrated care utilizes documentation within the patients EHR record to track provider collaboration.

Even something as brief as, “Client J. Smith requires a medical evaluation appointment. When can you see him?” must be sent through the protected electronic system. Not only does the continuity of patient care hinge on this relatively new practice, but so too does the facility’s ability to bill for client services.

One challenge here – especially for clinicians who did not begin their careers in the digital age – is building new automatic habits to maintain compliance and thorough recordkeeping to protect patient care. The other challenge here is that appropriate documentation must be utilized to efficiently bill for both providers’ time.

Bringing Peers Together

As the Arizona Health Care Cost Containment System (AHCCCS) has so succinctly illustrated in their infographic depicting the ideal flow of patient care, we are all striving for a world in which physical and behavioral health care work together, rather than separately – or, in truly chaotic cases, against each other.

Ideally, a medical professional and a behavioral health clinician could sit together in a room and serve a patient concurrently. This would allow both sides of the treatment to have access to the same information, observe the patient under the same conditions, and collaborate productively to create a treatment plan that is in unison with the client’s best interests.

At first, this presents an awkward social dynamic. Doctors have operated in a silo for so long and now they are being asked to sit in a room with a peer while providing care.

Additionally, the way our current reimbursement system is structured, treatment centers are unable to bill for both the physical and behavioral health services if the client is seen by both treatment providers at the same time.

Rather than maximizing the patient’s and clinicians’ time while providing a richer client care experience, we are hamstrung by billing regulations.

The Third Wheel

Technology has already become the third wheel in the room in our daily lives and it is beginning to emerge as a problem in the healthcare space, as well. While clinicians would rather spend their time interacting with a patient and paying close attention to detect those subtle nuances of behavior that could make or break the success of a patient’s treatment, they are being asked to sit at a computer and type while serving the patient.

Not only does this break down rapport between the patient and clinician, but it also disrupts the quality of patient care that facilities strive to provide.

If a clinician opts for completing notes after an appointment, he or she is faced with a new burden. Oftentimes clinicians find themselves spending 5, 10, or even 20 times as much of their time maintaining EHRs than they do in face-to-face patient interaction.

The challenge here becomes: How do we protect the quality of care patients receive while maximizing the efficiency of EHR requirements?

The Future of Integrated Care

Document, document, document – this concept has been drilled into service providers on both the behavioral and physical care sides since grad school. However, the same is not always true for support staff, which leaves room for critical elements to fall through the EHR cracks.

Furthermore, the heavy emphasis on IT as a necessary element of treatment continues to be a new concept that has been met with resistance for years.

But there is hope.

According to a qualitative research study published by The Commonwealth Fund, consolidation of physical and behavioral health services agencies “has led to increased attention to behavioral health services and behavioral and physical health integration, enabled more strategic purchasing and streamlined regulatory processes, and enhanced communication, collaboration, and mutual trust across sectors.”

To achieve these same goals, it is first necessary to help healthcare executives understand what their program goals are, who they serve, and the expected outcomes they hope to achieve. With that foundational understanding, we can design IT systems that will facilitate goals in an organic way rather than as an imposition.

Furthermore, we need to work together with health plans to ensure everyone understands the optimal means of delivering quality integrated care while resolving often meaningless billing obstacles.

For a truly integrated physical and behavioral healthcare system to exist, we need top-down leadership. Until there are prescriptive federal guidelines governing integrated care, there will be nothing smooth about these processes. It must be a mandated process with standardized guidelines for how to carry out integrated care that will guide small, medium, and large service provider organizations and networks.

The goal is harmony; harmony in life, harmony in business, and harmony in various avenues of patient care. By calling out the challenges and coming together to implement sustainable solutions, we can achieve harmony.