Walking the Tightrope Without a Net: Integrated Care for the Patient with Diabetes, Cardiovascular Disease, and Bipolar Disorder…and No Insurance

Abstract

The past two decades have brought about a transformation in the role of the nation’s community health centers (CHCs). CHCs provide comprehensive health care services to communities and populations that have been designated by the federal government as “underserved.” However, these changes have been ushered in due to a diminishing number of community mental health centers and growing pressure from the Health Services and Resources Administration; as a result CHCs are faced with the challenge of encompassing behavioral health within their scope of services. With the increased focus on combination of primary and behavioral health services, CHCs have had an opportunity to develop and implement innovative integrative integrated delivery systems to meet the health care needs of the community. The movement towards integration of services has been fueled by a growing body of data indicating primary care is the most likely point of access for people with mental health disorders. Improved medical outcomes along with improved patient and provider satisfaction have strengthened the argument for integrated service delivery models. As a hybrid community health and mental health care organization, Cherokee Health Systems (CHS) has emerged as a “safety net” for a growing population of uninsured and underinsured, many of whom face complex medical, behavioral, and social problems. CHS is a comprehensive community health care organization with 14 primary care offices in 11 counties in east Tennessee. Originally a community mental health clinic, CHS began providing primary care services in the 1980s to address the unmet health care needs of the community. With a unique combination of primary and behavioral health professionals who work together to provide collaborative care, CHS implements a clinical model of integration that involves both behaviorists embedded in primary care as well as on-site traditional mental health professionals. This structure of integration allows for increased provider communication and interaction, integrated health records (including both medical and behavioral information), shared clinical and waiting space for patients, formal multidisciplinary treatment teams, and integrated treatment planning. As a single entity, CHS is also able to streamline administrative and financial systems (i.e. consents, privacy information, billing) to maximize continuity of care for patients receiving care from multiple providers (i.e., physicians, psychologists, and psychiatrists).