NHMH – No Health Without Mental Health a 501(c)(3) nonprofit
PEAK PERFORMANCE – Intermountain Healthcare & Mental Health Integration
IH’s health system includes 180 primary care clinics, 24 hospitals and its own health insurance plan. It oversees its own network of independent, community-based practices that are connected through standard quality metrics and clinical work processes paid through fee-for-service reimbursement.
Key to IH’s success is a common shared culture of patient/family-centered, high-quality, collaborative teams focused on patient’s needs, always improving workflows, and backed up by substantial outcome and process data that drives a single care process model that integrates, people, functions, and operations. Integrated team-based primary care normalize mental health as a routine part of every health encounter rooted in strong, trusting continuous relationships for patients and their families and the staff that care for them, connecting them with the right resources needed to reach and sustain positive outcomes.
Intermountain has engaged in integrated care for two decades and become known as the integrated care “implementation experts” relying heavily on a robust database system. Their priority is: What are the needs of the patient? In 1998 they asked their patients: “What is the biggest problem you face?” And the overwhelming response was: “Mental health care!” Putting patients first, IH knew it had to deliver integrated medical-behavioral care. Starting with University of Washington’s AIMS Center’s integration models (IMPACT, TEAMcare), IH went on to build their own integrated care delivery methodology and implementation approach.
Yet, at the same time, IH is the first to acknowledge that several aspects of their mental health integration approach are not widely generalizable to diverse practices across the U.S.:
* its structure (medical group, hospital, health plan) is a fully integrated delivery system;
* the medical group was/is key to building MHI (“We want happy doctors”);
* the entire IH system works in support of MHI, normalizing it;
* the medical group took on financial risk for doing MHI, e.g. analytics support, education, training.
Quality measures Intermountain developed include: (1) matching team care services to patient needs; (2) measuring and rewarding results over time; (3) developing clinical care process metrics, and (4) tracking through longitudinal actionable patient registries.
Brenda Reiss-Brennan, PhD, a psychiatric nurse practitioner working in primary care for 40+ years, early on developed an innovative business model to train primary care providers/clinics in mental health care and family systems concept. Starting her independent nursing family therapy practice in 1978, Reiss-Brennan routinely received referrals of patients with behavioral health conditions. These referrals were from PCPs unsure how to address their patients’ mental health needs.
In 1984 Dr. Reiss-Brennan developed a PCP training model on mental health care that caught the attention of IH and in 1998 her model was joined to a chronic medical care model to lay the basic foundation for IH’s Mental Health Integration (MHI) in Utah. In 2001 following excellent results of this pilot, IH asked Dr. Reiss-Brennan to join IH’s team and disseminate the MHI approach throughout their entire care delivery system.
Noteworthy is an addition to IH patients asking for mental health care, Intermountain took on mental health delivery at the request of its own PCPs. Integrating care, IH saw quality of care improved and realized cost savings; that led to happy doctors which in turn led to happy patients.
Brenda was part of efforts to re-design the IM workflow to encompass 5 key components:
leadership -> workflow -> HIT infrastructure -> financing –> community resource integration
Brenda and her IH colleagues have by now become recognized experts at integration implementation. The IH MHI model is designed to promote 3 primary care practice changes: (1) improve the detection, monitoring, stratification and management of depression and other MH conditions, (2) reinforce regular relational contact with patients and families to promote adherence and self-activation, and (3) adjust treatment if there is evidence of increasing complexity or inadequate patient response.
(For more detailed information on Dr. Benda Reiss-Brennan’s and IH’s MHI approach see link below to American Academy of Nursing March 2021 article).
Throughout her professional career, Dr. Reiss-Brennan has been an integral part of the development of a mental health integration approach that has enormously helped patients and families through vastly improved health outcomes and at lowered cost. IH has shown that successful integrated care can be done provided patients are linked to continuous, coordinated relationships with a healthcare delivery system delivering care through integrated care teams connecting mental and medical health. Takeaways from IH are that the two essential requisites are a health system putting patients needs first and embedding a culture of striving for high-quality care across the care delivery system.