{"id":4882,"date":"2016-03-02T00:00:00","date_gmt":"2016-03-02T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/03\/02\/act-shows-the-way-to-integrated-care\/"},"modified":"2021-07-08T12:34:44","modified_gmt":"2021-07-08T18:34:44","slug":"act-shows-the-way-to-integrated-care","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/act-shows-the-way-to-integrated-care\/","title":{"rendered":"ACT shows the way to integrated care"},"content":{"rendered":"
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The results are in from a pioneering five-year, $3.9 million experiment to see how eight primary care practices and three mental health centers across Colorado might integrate behavioral health and primary care. The biggest finding, the Advancing Care Together (ACT<\/a>) program\u2019s leaders at the University of Colorado School of Medicine say, is that integrated care can be done well in different types of clinics with diverse patient populations \u2013 but that local practices gain from the flexibility to tailor the approach to their particular circumstances rather than adopting one-size-fits-all templates.<\/p>\n

That\u2019s good news for UCHealth, which views care integration as central to its primary care practice transformation efforts.<\/p>\n

The findings, published as a special supplement<\/a> to the Journal of the American Board of Family Medicine<\/em> (JABFM), also pointed out two major issues that must be solved to enable integrated care on a large scale: improving electronic health records to enable better data capture and sharing across primary care and behavioral health, and reforming payment approaches to make sure clinics providing behavioral health services can afford to do it.<\/p>\n

Different strokes<\/strong><\/p>\n

\u201cAdvancing Care Together\u2019s primary goal was to change practice,\u201d Green said. \u201cAnd our method for doing that was to work with people with their own ideas and their own communities \u2013 not tell them what to do, but invite them to tell us what they thought they could do under local conditions.\u201d<\/p>\n

The clinics received up to $50,000 a year for three years, mostly for evaluation services and learning activities; many spent far more than that, Green said. \u201cThis was closer to maybe $15 million worth of work \u2013 just a huge amount of work by these amazing people.\u201d<\/p>\n

One of ACT\u2019s defining features was the diversity of the 11 participating clinics, which represented a range of publicly and privately owned, rural and urban. Denver Health and Kaiser Permanente, Green and colleagues assumed, would tackle care integration differently than Midvalley Family Practice in Basalt or Plan de Salud del Valle in Brighton. They were right.<\/p>\n

The practices were well-motivated. There is no shortage of data showing that integrating primary care and behavioral health \u2013 which encompasses mental health and substance use disorder conditions, health behavior change, life stressors and crises, and stress-related physical symptoms \u2013 pays off both financially and in terms of patient well-being. On the financial side, Steve Melek, an actuary and principal at Milliman who worked with the ACT team, estimates that care integration could save the U.S. health care system $26 to $48 billion \u2013 roughly 5 percent to 10 percent of the $525 billion spent each year on patients with behavioral conditions. He adds that those with behavioral conditions typically cost the health care system double to triple that of the average patient.<\/p>\n

The ACT report further highlights the prevalence of the problem: 20 percent of primary visits are mental health related; 67 percent of adults with behavioral health disorders don\u2019t get proper treatment; depression goes undiagnosed in more than half of primary care patients; two-thirds of primary care providers are unable to connect patients with outpatient behavioral health providers due to a shortage of providers and barriers created by insurance; depression and anxiety comprise two of the top five conditions driving overall health care cost (obesity, arthritis and back\/neck pain round out that woeful list).<\/p>\n

Larry Green, MD<\/a>, a CU School of Medicine Department of Family Medicine physician, and Maribel Cifuentes, RN, BSN, led the study. The Colorado Health Foundation paid for it.<\/p>\n

Key points<\/strong><\/p>\n

What did the ACT program find? While what worked varied from practice to practice, a few things stood out:<\/p>\n

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Maribel Cifuentes, RN, BSN, and Larry Green, MD, of the CU School of Medicine\u2019s Department of Family Medicine. Green and Cifuentes led the five-year, $3.9 million ACT behavioral health integration project.<\/figcaption><\/figure>\n