Physical and mental health are once again front-page news. Media outlets share warnings about “the psychosocial repercussions” of COVID-19 (Scientific American), and “that U.S. agencies have yet to properly prepare for the unfolding mental health crisis” (ABC News). The need for mental health care is, for many, more obvious than ever before.

The need
Yet this is not a new problem. According to the Centers for Disease Control and Prevention, 1 in 5 people in America experience mental illness each year, and mental and physical health are equally important to a person’s wellbeing.

Despite this, many face barriers to care, and only 50% of people referred to mental health care wind up receiving it. There is also a major health disparity for individuals living with Serious Mental Illness (SMI), such as schizophrenia and bipolar disorder. Individuals with SMI experience a severe mortality gap, dying 15-30 years younger than those without mental illness (NYTimes; see also: Preventing Chronic Disease, 3(2): A42).

1 in 5 people in America experience mental illness each year

People with Serious Mental Illness die 15-30 years earlier than those without

What we’re doing
HealthierHere and select partners plan to test 7 innovative new projects to better address mental health needs in coordination with physical health care for individuals with SMI and co-ocurring physical health conditions – otherwise known as integrated or whole person care. Each innovation is designed to be scalable once tested.

In late 2019 HealthierHere announced its ‘Testing Models for Integrated Care” funding opportunity. Part of HealthierHere’s Innovation Fund investments, this opportunity encourages organizations to “think outside the box” and try new, potentially better, ways of addressing gaps in our health care systems. Thanks to the HealthierHere Integration Design Steering Committee for their help developing this strategy.

We took a collaborative approach for our selection process. HealthierHere encouraged clinical partners to submit letters of interest, then engaged interested partners in conversations to assess their proposals’ potential and feasibility. We contracted with the University of Washington (UW) AIMS Center to help inform the selection process. UW AIMS – experts in collaborative care – will provide coaching and technical assistance to support the selected projects.

The goal
HealthierHere selected 7 promising partner-driven innovations to receive funding. Each aims to address the current lack of communication and shared protocols for people who visit multiple systems to meet their physical and behavioral health needs. Partners will test models that include:

We're testing innovations for integrated, whole person care

CHI Franciscan and Valley Cities Behavioral Health Care

    • Integrating behavioral health in a primary care setting via a behavioral health coordinator
    • Developing workflows to maximize use of collaborative codes
    • Focusing on linkages to specialty behavioral health as needed

Downtown Emergency Services Center (DESC) and Harborview Medical Center

    • Advancing a Health Information Exchange strategy and care pathways to better serve a shared panel of predominantly homeless or formerly homeless individuals
    • Determining the optimal health care team structure and workflows to serve patients seamlessly across the two systems.

DESC, Community Health Plan of WA, Public Health – Seattle & King County, King County Behavioral Health and Recovery Division

    • Assessing the feasibility of bundled payment arrangements in a value-based contract, to support multi-disciplinary teams providing Medication Assisted Treatment to community members with high needs who are currently or were formerly experiencing homelessness

HealthPoint Community Health Center and Valley Cities Behavioral Health Care

    • Testing a shared care management strategy for patients with Serious Mental Illness in the primary care setting
    • Using a common registry for the focus population
    • Enhancing coordination between Federally Qualified Health Center (FQHC) care coordinators and Behavioral Health Agency care managers
    • Testing of new contracting models with shared risk and shared reward for achieving population health goals

MultiCare Health System and Sea Mar Community Health Centers

    • Embedding an FQHC behavioral health team member in a hospital-based primary care clinic
    • Developing workflows to include billing at the FQHC encounter rate
    • Developing a financial model that could lead to sustainability

International Community Health Services and Asian Counseling and Referral Service

    • Developing and using a registry of shared patients
    • Providing home-based peer support services with remote monitoring capacity
    • Enhancing a mutually reinforced co-location model in all clinical sites

Seattle Children’s Care Network and Seattle Children’s Hospital Psychiatry and Behavioral Medicine

    • Developing and testing a robust pediatric collaborative care model
    • Establishing a learning collaborative to support pediatric primary care providers
    • Determining sustainability of this model

What’s next?
Due to COVID-19 impacts and HealthierHere’s desire to support our partners on the frontlines of our community’s response, we postponed the start of all ‘Testing Models for Integrated Care’ innovations until summer 2020. We will reassess timelines with our partners in the coming weeks so that we can resume this exciting work when the time is right. Stay tuned!