Integrated Health Care
"Integrated health care" (see Table below) means that mental health and
substance use disorders, i.e. mental conditions, become an integral clinical,
administrative, and financial part of physical health. This requires
that:
- Purchasers of health care contract for mental health as a core and integrated
part of physical health benefits and pay for them from a single funding pool.
- Health plans design essential benefit sets for all health contracts
so that condition health services are a standard part of all health products
with common coding and billing procedures. Management practices should encourage
mental condition service availability that is coordinated with other medical
care in primary and specialty medical settings.
- Providers, including practitioners and hospitals and clinics, coordinate
the majority of mental condition care with other medical services in a single setting, a unified clinical documentation system, and strong communication
among clinicians.
- Care managers, especially those assisting patients with health complexity, use relationship-based management methodology designed to integrate physical and mental condition support through a single manager.
| Operational Integration of Physical and Mental Condition
Care |
- Employers/Government Agencies
- Purchase health plan contracts that facilitate ease of payment for employee/enrollee
treatment in clinical settings in which active communication
and coordination of physical and mental condition services & providers
occurs without hassle
- Health Plans
- Benefits and contracting: create a single budget, which supports medical and
mental condition services; no separation of adjudication practices
- Consolidated practices: use a single payment pool, network of providers, claims processing system,
data warehouse, and actuarial projection for physical and mental condition support
- Customer and care management services: are integrated and outcome-oriented
- Health
Service Delivery Systems
- Inpatient and outpatient provider care
integration for comorbid patients in a unified physical and mental
condition delivery system
- Integrated
case management for patients with health complexity
|
| |
Integrated case management is a subset of integrated health care. It is
characterized by the individualized assistance given to patients with varying
degrees of health complexity in an attempt to help them overcome barriers
to improvement created by biological, psychological, social, and health
system factors. It brings value to purchasers, health plans, and care delivery
systems since it reverses poor outcomes in patients with high cost and
treatment resistance.
Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
|
