Table 1.

Lessons Learned by Early Innovators on How to Integrate Care in Your Practice: Selected Practical Examples from Participants in the Advancing Care Together Study at Their Closing Meeting, September 2014

1. Frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care
    a. Eliminate the division between physical and mental health at the clinical and organizational level to better meet patient needsEducate all clinic staff on what integration is and why it is important.
    b. Treat integration as the conceptual and operational framework for the entire organization rather than a separate initiative
2. Initialize–define relationships and protocols up-front, understanding that they will evolve
    a. Create a shared vision using common language that everyone understandsPut the shared vision and agreements in writing to help prevent future ambiguity.
    b. Create and verify consensus regarding what partnerships entailIdentify programs and features within integrated care that can generate revenues to sustainably continue the model, such as billing for case management.
    c. Establish standard processes and infrastructure necessary for your integrated care approach: workflows, protocols for scheduling and staffing, documentation procedures, and an integrated EHR
    d. Determine the practice's risk tolerance, pursue funding opportunities, and commit to your integration approach
3. Build inclusive, empowered teams as the foundation for integration
    a. Create inclusive care teams, centered around the patient and their needs, where all members have an equal voiceInclude BH providers in planning meetings regarding clinic organization and finances.
    b. Invest in relationship- and trust building among team members by scheduling regular multidisciplinary, interprofessional communicationSchedule regular (at minimum biweekly) meetings for the team to be together for case reviews, shared care planning, and/or morning huddles.
    c. Find the right people for the team with the necessary skill sets, experience, and mentalityHire a practice manager with not only office management skills but also relevant project management skills such as grant writing, negotiating with insurance companies, and awareness of policy levers and barriers.
    d. Identify leaders at all levels
4. Develop a change management strategy of continuous evaluation and course-correction
    a. Create a culture open to learning from failureAsk providers to discuss both failures and successes at meetings with their peers to normalize failure within the process of change.
    b. Cultivate support for change within and outside of the practiceDevelop a plan for increasing awareness amongst patients about integration and available services (possible themes for patient messaging could include “one-stop shop,” “we specialize in all of you,” “whole-person care.”)
    c. Encourage a broader-scale call for integration by engaging patients early and often
5. Use targeted data collection pertinent to integrated care to drive improvement and impart accountability
    a. Collect data on defined, priority outcomes to measure your progress toward integrated care and also to demonstrate the value of integrated care to external stakeholdersRoutinely provide outcomes data to individual providers on their performance compared to practice averages as well as target levels.
    b. Create feedback loops for data to inform quality improvement efforts
    c. Report data internally both at the level of the practice for shared accountability and at the individual provider level to motivate change
  • EHR, electronic health record.