Vertical & Horizontal Integration: One True Compass to Bring Physical & Behavioral Health Care Together

May 8, 2018

“Integration” is one of those sneaky words that appears in almost every discussion about healthcare. And in every application, it seems to be used in a new way.

But it is not the speaker’s fault.

The confusion is rooted in the word itself and how it relates to our complex healthcare systems.

In truth, there is nothing simple about our modern healthcare systems, which compound in complexity with every new layer of regulation and technological advancement.

It makes sense then that integrating various aspects of our healthcare systems becomes increasingly more complex – as does the discussion surrounding such a laborious task.

Oversimplification is Complicated

While we likely can all agree that “integration” refers to bringing together the physical care and behavioral health treatment of patients collaboratively within the healthcare space, there is far more to it than that.

Moreover, simplifying the discussion to that brief description can actually harm our efforts to succeed in integration.

Part of the reason why we are struggling so much to fully marry physical and behavioral healthcare integration is that we are failing to look at both the horizontal and vertical aspects of the process through the correct lens.

In a perfectly simple world, we could have physicians and mental health professionals working together seamlessly on each patient case – and that is often what we envision when we use the word “integration.” Yet, once we step outside of the treatment room, there is a whole world of healthcare administration, governance, insurance and billing, and technology that has yet to integrate.

This is precisely where we need to concentrate our efforts from the right perspective so that the administrative and regulatory sides of physical and behavioral healthcare integration can come together as smoothly as we would like and as patients deserve.

Horizontal Integration

According to the Essential Hospitals Institute and the Pan American Health Organization, horizontal integration is “the coordination of activities across operating units that are at the same stage in the process of delivering services.”

In other words, horizontal integration relates to how we organize the schema of healthcare systems across the country. Just like we have broken the nation into states and states into counties, our healthcare system is broken down into regions, systems and groups.

The unique challenge within horizontal integration is that oftentimes competitors are grouped together and expected to work with one another; yet there is a great deal of hesitation for fear of giving away trade secrets and losing billable work to a competitor.

However, we should look at horizontal integration as a means of improving the quality of care all patients are provided and identifying the best practices that will serve the greater good.

Vertical Integration

Turning back to our standardized definitions, the Essential Hospitals Institute and the Pan American Health Organization define vertical integration as “the coordination of services among operating units that are at different stages of the process of deliver[ing] patient services.”

In a 2014 article, commentators Maruthappu, Hasan, and Zeitner illustrate the concept of vertical care in terms of a supply chain: “Vertically integrated care pathways take patients from first contact to specialist to ongoing care.”

However, it is not enough to simply envision vertical integration in terms of economics. Rather, in order to successfully integrate physical and behavioral healthcare vertically, we must envision the healthcare system from the eyes of the patient – our true compass.

A True Compass

The whole purpose of our physical and behavioral health care systems is to improve the quality of life for patients. We have countless talented physicians, specialists, mental health professionals, and researchers working tirelessly to serve others. Yet the matrix in which they are working is stifling the process and hindering our true goal.

As we work to legitimately integrate physical and behavioral health, we must conceptualize the problem from the perspective of the patient and never lose sight of the powerful why behind the work we do.

To maximize the success of vertical integration, we must ask questions like:

What is the journey the patient takes? How is it experienced? Where do we stumble? Where does communication fail as the patient progresses from intake to specialist appointments to prescriptive treatment to aftercare? What community resources will the patient need access to and who will need to communicate with each other in order to make those resources known and available to the patient?

Likewise, to succeed in horizontal integration, we must ask ourselves and our colleagues:

Are patients in one geographical region enjoying more successful or better integrated care than patients in other regions? How do various networks stack up against one another? What are the best practices that derive the results our patients deserve and how can we implement them across various networks, groups, and regions?

No matter where you fall on the map of the American healthcare system, we must all follow the same true compass. With us all traveling in the same direction together, we can transform the landscape and achieve integration.