The Keys to Integrated Health Care

Caring for the whole patient, collaborating among practitioners becoming the norm

Does your practice or organization combine primary care with behavioral health and nutrition services? Perhaps some complementary therapies, as well? If so, you are already familiar with aspects of the integrative health care model. 

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Varying definitions of integrated health care

You may hear at least two variations on the definition of “integrated health care,” depending on who you are talking to, but the concepts have several similarities.

Mental health professionals and some primary care physicians may refer to integrated care as practitioners working together to address behavioral or psychological health issues along with physical health issues.

This collaborative model is especially important when dealing with substance abuse issues, eating disorders, dementia and other issues that can take a tremendous mental and physical toll on patients.

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and health services to better address the needs of individuals with mental health and substance abuse conditions, whether seen in specialty behavioral health or primary care provider settings. CIHS is funded jointly by the Substance Abuse and Mental Health Services Administrations (SAMHSA) and the Health Resources and Services Administration (HRSA).

But some group practices or health systems have taken the integrative care concept a bit further, to include alternative or complementary therapies.

The National Center for Complementary and Integrative Health defines integrative care as care that brings together conventional and complementary approaches in a coordinated way.

A practice that embraces complementary approaches might incorporate mind and body practices like yoga, meditation, relaxation techniques like guided imagery, tai chi and massage therapy, or additional complementary therapies.

Integrated care has been growing in popularity in recent years for a few reasons. First, people increasingly want this type of care and want to take an active role in their own health, noted Chiti Parikh, MD, co-director of Integrative Health at Weill Cornell Medicine in New York.

“Patients are asking for it,” she said.

Secondly, integrated care now has a solid clinical evidence base to support it. “What we do is based on evidence,” said Joseph Feuerstein, MD, a family practice physician and integrative medicine specialist for Stamford Health in Connecticut.

Multiple benefits of integrated care

Why combine various types of care into one practice?

The National Institute of Mental Health maintains that “addressing the whole person and his or her physical and behavioral health is essential for positive health outcomes and cost-effective care.” Combining the provision of mental health services with primary care into one setting can “reduce costs, increase the quality of care, and ultimately, save lives,” according to the NIMH.

“We’re starting to wake up to the reality that as the cost of healthcare snowballs and starts to get out of control, we need to shift our gears and focus on prevention,” said Parikh, noting that even insurance companies are starting to cover many preventive care services.

But a few misconceptions about integrative care may still exist.

As Feurstein noted, some people may not realize the “robust clinical evidence for its effectiveness.” That basis is important to him, and it’s important to the well-being of his patients. His medical center even has a two-year fellowship in this specialty, and numerous academic medical centers now have centers for integrative health.

Additionally, some people may assume that the services offered in many integrated care practices are a luxury. Some may assume that they only apply to a certain type of patient or a certain type of patient population.

Not true, said Parikh. “I like to say, ‘We don’t treat symptoms or disease. We treat people.’ So anyone can benefit from the integrative model,” she said.

Her own practice is growing. The team currently has two physicians, a nutritionist, a nurse who specializes in mind–body therapies, a massage therapist, and a licensed acupuncturist, with plans to bring a clinical psychologist on board in the very near future. They are all focused on creating a setting where patients can access all the kinds of care that they need.

“It just makes sense,” said Parikh.

Want to build an integrative practice?

It’s important to really understand your patients and what they need--and what they want. Parikh suggested physicians who are considering an expansion of services should start out by informally surveying patients to find out what kind of services they desire and how they believe those services would help them get (and stay) healthier.

“You have to really know your patient population that you’re serving,” she said. “Then you can develop a model that fits their needs.”

You could also check with referring physicians to see what they’re seeking. You may be able to develop some partnerships with other physicians and share resources where appropriate.

Becoming part of a collaborative care team, even across practice settings

Regardless or practice size or one’s exact role within a practice or health system, it’s becoming more important for physicians and other practitioners to embrace the team aspect of the integrative care model, sometimes referred to as “collaborative care.”

When a doctor contacts Feuerstein for a consultation, he always makes sure to keep them in the loop. He lets the referring physician know that he’s suggested a lifestyle change such as a nutrition plan or a sleep improvement plan, for example.

“We want to be able to coordinate care,” he said. “We want them to know what we’re doing so they’re fully appraised of what’s going on.”

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