Highlighted Project: Integrating Behavioral & Physical Health Care

In 2014, CORE and Oregon Health & Science University began a unique and comprehensive three-year research project to learn and share what patients need from an integrated system and the barriers that keep providers from delivering it.

Health systems looking for the best way to integrate behavioral and physical health care don’t have a lot to go on. While there have been pilot projects around the country, they have, for the most part, happened outside the mainstream of the local health care system.

Under Oregon’s coordinated care model, all payers are looking at ways to better integrate mental and physical care. In the Medicaid system, coordinate care organizations are responsible for outcomes for the whole person and all care is managed under a single global budget. Other payers are also looking at ways to follow coordinated care. This creates an ideal testing ground to asses the full potential of integrated care on the lives real people.

“Tomorrow I have two appointments with two different mental health providers and I don’t even know why I am seeing two. Why should I be there for five hours: a 1:00 appointment and a 3:00 appointment? I haven’t even been in for a follow-up on my skin or my arthritis (or what I suspect is arthritis) and COPD, because I know they’re not going to be compassionate. It’s like they just don’t care.” - Oregon patient

Patients at the center: To ensure that patient needs were always at the center of the work, CORE convened a Patient Advisory Team. Through that team, patients drove the development of the research question, participated in subject recruitment plan, determined the outcomes that are measured, designed the data collection tool and helped in the analysis, interpretation and sharing of data. The Oregon chapter of the National Alliance on Mental Illness (NAMI Oregon) is also partnering on this project.

Broad scope: For this project, CORE is partnering with thirteen clinics across Oregon that primarily serve low-income populations and that fall at varying places along the continuum of care integration. The range from fully integrated, including the billing system with providers co-located, to not integrated at all. These partners represent a range of different locations, both urban and rural and collectively see approximately 34,000 adult patients annually.

Surveys: Baseline data was gathered through surveys sent to approximately 11,500 patients and follow up interviews with 62 survey respondents. CORE also surveyed lead staff at the 13 partner clinics to identify each clinic’s integration strategies. The second year survey is fielding in the fall of 2016.

This study could help improve health care and outcomes for a significant number of Americans. A recent study found that of the 37.5 million U.S. adults under 65 who have a mental disorder, 6 million had hypertension, 5.3 million had asthma, 2 million had diabetes and 1.4 million had heart disease (56); these behavioral health problems may make self-care more difficult (57). The prevalence of co-occurring mental and physical health conditions is even higher among low-income and vulnerable populations: our previous research suggests that one-third of low-income adults in Oregon may have both chronic physical and mental health diagnoses and Medicaid enrollees with both mental and physical health problems are nearly four times more likely to die than the general population.