Models of Integration

Advantages and Weaknesses at Each Level of Collaboration/Integration

COORDINATED
Level 1
Minimal Collaboration
Level 2
Basic Collaboration at a Distance
Advantages
  • Each practice can make timely and autonomous decisions about care
  • Readily understood as a practice model by patients and providers
  • Maintains each practice’s basic operating structure, so change in not a disruptive factor
  • Provides some coordination and information-sharing that is helpful to both patients
Weaknesses
  • Services may overlap, be duplicated or even work against each other
  • Important aspects of care may not be addressed or take a long time to be diagnosed
  • Sharing of information may not be systematic enough to effect overall patient care
  • No guarantee that information will change plan or strategy of each provider
  • Referrals may fail due to barriers, leading to patient and provider frustration

 

CO-LOCATED
Level 3
Basic Collaboration Onsite
Level 4
Close Collaboration Onsite with Some System Integration
Advantages
  • Colocation allows for mare direct interaction and communication among professionals to impact patient care
  • Referrals more successful due to proximity
  • Opportunity to develope closer professional relationships
  • Removal of some system barriers, like separate records, allows closer collaboration to occur
  • Both behavioral health and medical providers can become more well-informed about what each can provide
  • Patients are viewed as shared which facilitates more complete treatment plans
Weaknesses
  • Poximity may not lead to greater collaboration, limiting value
  • Effort is required to develp relationships
  • Limited flexibility, if traditional roles are maintained
  • System issues may limit collaboration
  • Potential for tension and conflicting agendas among providers as practice boundaries loosen

 

INTEGRATED
Level 5
Close Collaboration Approaching an Integrated Practice
Level 6
Full Collaboration in a Transformed/Merged Integrated Practice
Advantages
  • High level of collaboration leads to more responsive patient care, increasing engagement and adherence to treatment plans
  • Provider flexibility increases as system issues and barriers are resolved
  • Both provider and patient satisfaction may increase
  • Opportunity to truly treat whole person
  • All or almost all system barriers resolved, allowing providers to practice as high functioning team
  • All patient needs addressed as they occur
  • Shared knowledge base of providers increases and allows each professional to respond more broadly and adequately to any issue
Weaknesses
  • Practice changes may create lack of fit for some established providers
  • Time is needed to collaborate at this high level and may affect practice productivity or cadence or care
  • Sustainability issues may stress the practice
  • Few models at this level with enough experience to support value
  • Outcome expectations no yet established