ntegrated care is not a new concept, but it is growing in popularity as health care providers and patients experience the benefits of a system that focuses on a person’s overall health and well-being. Integration requires a high degree of collaboration and communication between interprofessional team members. It’s unique because these care professionals share information about patients in order to come up with a treatment plan that addresses the physical and psychological needs of a patient.
The Intensive Outpatient Clinic (IOC) at University of Utah Health was specifically designed as an integrated care model, bringing together primary care physicians, behavioral health practitioners, and a whole team of health care professionals in a single care location. This team focuses on the unique needs of patients with significant trauma, depression, anxiety, and the challenges that often come along with that—such as addiction, homelessness, and abuse.
It began with visionary leadership and an entrepreneurial spirit
The idea to open a clinic like the IOC began with the vision of Peter Weir and the support of the Associate Vice President for Clinical Affairs at the time, the late Edward B. Clark. Edward mentored Peter, encouraging him to expand population health services at University of Utah Health by opening a clinic that would take a different approach to treatment. He brought Peter on as the IOC Medical Director to implement his vision of a comprehensive treatment clinic for a very underserved population.
Another key partner in getting the clinic off the ground was University of Utah Health Plans. Peter and Stacey Bank introduced the concept of a clinic that could improve outcomes for a high-risk, high-cost population and do it in a way that would save money as well. U of U Health Plans agreed to invest in the model that would bring all the key players together in a single location—working together, collaborating, and caring for patients.
The goal was to balance traditional health care to address patients’ clinical needs with behavioral health care to provide for their mental health needs.
How it works in practice
On a typical day at the IOC, our behavioral health and clinical teams meet one-on-one with patients and provide individualized care based on their needs and their treatment plan. Behavioral health providers establish goals with each patient, then help create a plan that supports those goals. Clinical teams work alongside the behavioral health teams to address acute care needs as well as help patients manage long-term chronic health conditions.
For many patients, these poorly managed or untreated chronic conditions eventually result in an emergency department (ED) visit or hospital admission. But with little to no continuity of care or follow-up, the conditions usually progress to more serious health issues. By treating both mental and physical health together, we can minimize costly and ineffective treatment from ED visits, lower costs and improve the patients’ long-term health and well-being.
In addition to the care providers in our clinic, we also partner with psychiatrists from Huntsman Mental Health Institute (HMHI), providers in the addiction fellowship program, and a home health nurse who can help our patients who are homebound or who don’t have transportation to get to the clinic. When our interdisciplinary team meets, everyone has input on what’s happening and what each patient needs—whether that is behavioral health, clinical care, transportation, or something else.
The team is small and nimble, not unlike a startup culture. Everyone is ready to respond to what’s happening in the moment, without the constraints of a typical clinical environment. The population we serve is unique and their needs can fluctuate from day to day. Some patients are with us for many years, others for very intensive treatment over a short period of time.
The benefits of integration
There are many benefits to an integrated clinic, but one key benefit is how we share the load among all our team members.
Every member of our team has an equal voice to speak up, recommend treatment, or ask questions. We all know what’s happening with each of our patients, and have a very collaborative environment.
If someone is seeing a patient for therapy and the patient has a question about medications, the therapist can come to the office and find a clinical provider to address that in the moment.
We also have a very supportive network. We all understand how hard this work can be. We talk about our feelings, cry, go to therapy, and share tips on self-care. It’s very different from a typical medical practice, where there is a constant focus on the work, and how much you can give of yourself as a physician or provider to keep your patients happy. We actually subscribe to the “oxygen mask” theory—that you have to secure your own oxygen mask before you will be in a position to help others. I don’t feel like I’m on a hamster wheel anymore. There is a way to make an impact with patients without sacrificing your own health and well-being.
The long road to value
The IOC is what the National Council for Mental Wellbeing refers to as a “Level 6 Full Collaboration Integrated Practice.” That means care providers work in the same space and “communicate consistency at the system, team, and individual levels” with formal and informal team meetings, as well as roles that tend to blur or blend together.
Advantages of an integrated practice are numerous, and include:
The ability to truly offer “whole-person” treatment to each patient
Few or no system barriers that typically get in the way of team-based care
Shared knowledge and expertise among providers with each person able to contribute based on their unique specialty and training
The ability to address all a patient’s needs as they come up
But one of the biggest barriers standing in the way of integrated clinic implementation is often the cost. Creating a sustainable clinic with the right mix of expertise, ongoing funding, and support at the highest level is not easy. It takes time for health care systems that make this investment to see the ROI.
We now have up to three years of data showing cost savings in multiple areas, including fewer ED visits and lower rates of hospitalization in what is typically a very high-risk population. We have a proof of concept that we can use to move forward.
The best possible outcome: patient-centered care
All health care facilities are interested in patient outcomes. What we’ve built is a model truly centered around the patients we serve and their needs. It’s an innovative model where everyone on the team has equal voice and equal weight, and we give equal attention to patients’ behavioral and physical health. It’s one of only a few truly integrated clinical models and it’s working.