If we were to examine the leading causes of death within a typical community of modest size and diversity, we would likely find heart disease, cancer, stroke, respiratory diseases, diabetes, Alzheimer’s, and possibly suicide. If we switched our lens to causes of disability, we would probably see depressive disorders, anxiety disorders, and substance use disorders on the list. If we turned to risk factors for premature death and disability, we would find smoking, overweight, poor diet, sedentary lifestyle, and substance abuse.
One thing we would probably not see among the statistical summaries is the number of people who have combinations of chronic physical conditions, behavioral health challenges, and oral health problems. Yet if we ask our local clinicians, they will tell us story after story about patients presenting with multiple risks across these domains of health. They will also describe the clinical challenges of treating patients who have potentially deadly combinations of physical illness, mental illness, substance use problems, and oral health problems. How can we motivate a patient to manage their diabetes if they are also struggling with depression? How can we help a patient with high blood pressure practice healthy eating if their mouth is full of pain?
These are not easy questions to answer, but they are not uncommon, especially in safety net health care settings. Here we have an opportunity to learn from safety net providers who are taking steps to create patient-centered care models that integrate medical care, dental care, and behavioral health care. We also have obstacles to address in the form of distorted payment models, health information technology gaps, and educational programs that silo the disciplines of medicine, dentistry, and behavioral health. These obstacles are standing in the way of what community clinicians really want to do, which is provide excellent care within a comprehensive, integrated care model.
This is a time of great uncertainty for the future of health care. It can also be a time of opportunity if we use it to spotlight the need for integrated care models that will improve health and contain costs. As starting points, we can think about how to advance integrated care models through collaborative strategies in which:
- Community providers are laboratories for designing and testing integrated care models.
- Health foundations are strategic conveners, connectors, and co-funders.
- Health plans, Accountable Care Organizations, and State Medicaid agencies are policy partners and payment innovators.
- Health professions education programs are producers of inter-professional training activities.
- Advocacy groups and public health agencies are sources of insight and guidance.
- Federal agencies such as CMS and HRSA are catalysts and sources of innovation funding.
- Elected officials are policy leaders for systems of care that improve health and contain costs.
This is a daunting agenda, but good things are already happening. We can accelerate this work by starting strategic conversations within our own spheres of influence. Contact Community Health Solutions to learn more.