OM: Behaviorally-led Primary Care is Prefered Method of Integration

Advice On Integration – From 40 Years Of Doing It

By Monica E. Oss, CEO, Open Minds


Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325,  All rights reserved


Greetings from New Orleans, where this morning we kicked off the 2013OPEN MINDS Planning & Innovation Institute! Today's exciting agenda started with Dr. Dennis Freeman, Chief Executive Officer of Cherokee Health Systems, delivering the keynote address - From Concept To Sustainability - Making Integration Work premium members.

There was one key element of Dr. Freeman's presentation that has stuck with me in particular – integrated models are not "primary care + behavioral health." The integrated model that seems to stand the test of time (both financially and clinically) is behaviorally-led primary care. And, in this model, the "behavioral health" element is not behavioral health illnesses but health-related behavior management (more on that a little later this week).


Dr. Freeman expressed his concern about the financially stability of many of the emerging integrated services delivery models. A concern that is based on five common situations in these emerging models:

  1. Retaining a "specialty" mind-set when a more generalist vision is needed
  2. Using the old staffing and administrative models when a new organization is needed
  3. Recruiting primary care providers during a primary care provider shortage
  4. Relying on grant support instead of sustainable funding
  5. Failing to recognize and adapt to primary care as a volume-driven business


His advice - based on 40 years of experience - for the organizations that are developing an integrated service delivery model?

  1. Patients always point the way - Primary care is the portal into the health care system, and the system needs to change - not the patients.
  2. Mission is the compass - An organization can't be integrated if it doesn't truly want to be integrated.
  3. Developing the care model takes work - Just showing up (or saying you are developing an integrated model) is not enough.
  4. Bring value - The importance of this is twofold: Always be able to demonstrate your financial value, but also, always strive to serve the greater good.
  5. Friends in high places can be helpful, though not essential - No organization is an island, and asking for and receiving help can be very important. But even if you don't have that support, success is still possible.
  6. Payment methodology - Don't forget that payment is not the vehicle - it is the fuel.
  7. Contracting is a high stakes game - Payment may be merely the fuel, but fuel is necessary. Know your contracts because your contracts ARE your reality.
  8. Not every behaviorist can make it in primary care - At the end of the day, not every organization can make it in a primary care setting, and it will take a level of planning and wisdom to recognize which ones can and can't.
  9. Just do it - Eventually the planning must stop, and implementation must begin.


Tomorrow kicks off day two of this year's Planning and Innovation Institute - our deep dive into health homes from state mental health directors and CMHC executives who are "just doing it." If you couldn't join us here in New Orleans, follow our live updates on Twitter@openmindscircle #PII13.