A Vision for Integrated Care
By Tad Gary, M.Ed., Deputy Chief Executive, and Gagan Singh, MD, Chief Medical Officer, Mercy Care
From Print - Fall 2022
Arizona health care leaders have long had a vision for streamlining and integrating physical and behavioral health care. For many patients, that vision is a reality. Integrated health care is provided by a team of interdisciplinary health care professionals focused on a systematic approach to delivering coordinated, collaborative, and cost-effective care that improves members’ overall health, wellbeing,
and resiliency.
The Arizona Health Care Cost Containment System (AHCCCS) started phasing integrated services into health care in the late 1990s with the Arizona Long Term Care System (ALTCS). By 2014, people with a serious mental illness (SMI) were also receiving integrated care.
Before integration, Arizona’s public health system was fragmented. Individuals and families eligible for AHCCCS had one health plan for their physical health care needs and another for their behavioral health. They had to navigate between different health plans, different provider networks and appointments at different locations.
By 2018, AHCCCS offered integrated care to nearly all its members with the AHCCCS Complete Care, or ACC, contracts. In 2019, the Division of Developmental Disabilities awarded statewide contracts to Mercy Care and another managed care organization to deliver integrated physical and behavioral health benefits to individuals with developmental and/or intellectual disabilities.
Today, Mercy Care provides integrated health care for all Medicaid-eligible adults, families and seniors, individuals with an SMI designation, general mental health and substance use concerns, developmental and cognitive disabilities, children, and youth in foster care and those enrolled in Medicare.
Why Integrated Care
Practitioners trained to address mental health or substance use concerns may not focus on the patient’s physical health. On the other hand, primary care providers may focus only on a patient’s physical complaints and not consider that mental health or substance use concerns may be linked to the root causes leading to their poor physical health.
Consider that about 35 million Americans have diabetes, and they are 2 to 3 times more likely to develop depression than people without diabetes. But only 25 to 50 percent of those living with diabetes are diagnosed with and treated for depression, according to the Centers for Disease Control and Prevention.
Integrated care makes sense. You can’t separate the head from the body. Integrated care ultimately helps drive us towards the quadruple aim of helping improve the quality of care our members receive, while improving their satisfaction and reducing cost of care. In addition, it has been shown to improve satisfaction for health care providers.
Leading in Integrated Care
Our local, nonprofit health plan has led transformational changes to the state’s behavioral health care system. We were executing on what a growing body of research was confirming—to achieve better health outcomes, we needed to take a wholistic approach.
In those early days, we took a two-model approach with the development of integrated health homes and virtual health homes.
An integrated health home is a place where people receive coordinated treatment for all their needs—primary care, behavioral health care, care coordination, specialty health service referral, medication management, health promotion, prevention, wellness services, member and family health education services (e.g., chronic disease management, healthy lifestyle, etc.), evidence-based programs (e.g.,
supported employment, peer support services, etc.), case management and outreach services.
Our virtual health homes are for members who choose to stay with their primary care practice or behavioral health clinic which are not integrated. Health coaches at the primary care office and community-based case managers on the behavioral health side serve to integrate a member’s health care by working with each other, the member, the primary care physician and the behavioral health provider to coordinate care, medications and promote wellness.
In 2015, Mercy Care engaged Arizona State University to create a customized provider integrated health training and a ‘train the trainer’ program. This training was provided to integrated health home providers on best practices for integrated care and interprofessional teamwork.
Advancing Integrated Care
Mercy Care continues to collaborate with community organizations and provider partners to expand and transform integrated health care.
We have value-based contracts to incentivize both improvements of physical health for SMI populations and for enhancing behavioral health care for those receiving health care through ACC and other contracts.
In addition, Mercy Care has codes to allow primary care practices to bill monthly services using the psychiatric collaborative care model. This is an evidence-based model of care that puts the PCP-patient relationship at the center of all care with added support from a behavioral care manager and psychiatrist.
As we learn more about managing the care of the whole person, it is also obvious that managing the social determinants of health becomes more important. We have thus incentivized our providers in value-based arrangements to measure and report SDOH. In addition, we are working with AHCCCS and Contexture, our state health information exchange, on a closed loop referral system for managing SDOH. We also make Pyx, an app for managing loneliness and SDOH, available to our members. The health plan also created Mercy C.A.R.E.S., a community reinvestment grants program that supports agencies that share our focus areas of chronic illnesses, housing security, substance use and health and wellness. Since 2016, Mercy Care has reinvested more than $9.5 million worth of grants across Arizona.
In summary, we truly believe that everyone, regardless of age, income, or medical condition, can achieve better health outcomes with a holistic integrated approach. Such care improves outcomes, patient and provider satisfaction and makes Arizona health care more sustainable. We hope to continue to lead the way in collaborations to enhance integrated care.