Violent vivid lightening, punctuated by pervasive piercing thunderclaps and monotonous moving rain, has been a hallmark of Summer 2014. Similarly, this summer has witnessed the “sturm und drang” of a tectonic cultural shift fostered by the Affordable Care Act (ACA) to develop integrated primary care medical homes and integrated behavioral health homes. Some very promising efforts focused on collective wellbeing even extend these endeavors to encompass neighborhoods or communities. The purpose is to make available a “one stop shop” for illness care, to facilitate disease prevention and health promotion, and to reduce cost—the “Triple Aim” so well articulated by Don Berwick, the brilliant health policy observer.
Unfortunately, this enthusiasm only infrequently extends to a careful analysis of the human resources required to staff these new medical and health homes. Clearly, these emergent homes will require fully integrated care teams that include primary care physicians, behavioral health specialists, peer supporters, and potentially other specialists as well, depending upon the nature of the population covered by the home. For example, an elderly population will require a different team configuration than a working-age population.
Several months ago, I described a new role for peers in medical and health homes—an Integrated Peer Supporter (See here). This new role will involve support, mutuality, and recovery assistance not only for those with behavioral health conditions, but also for other clients with physical illnesses or chronic diseases. The Integrated Peer Supporter must be a full member of the integrated care team.
Here, I would like to introduce another essential role for medical and health homes. This role—the Health Home Integrator—will provide essential support to the integrated care team and to the client. Persons who engage in this role will have two primary functions: organizational coordination among health home components and personal coordination for each client.
Organizational Coordination: Most medical and health homes will not be unitary entities. Rather, they will be umbrella organizations that bring together pre-existing health care providers. For example, the home may join together a primary care practice with a community mental health center. More complex homes likely will have more than two constituent organizations.
To get the integrated care team to function well, professionals and peer supporters will need to be coordinated for each health home client. Logistically, this means coordination of schedules, other resources like space or transportation, and even fostering or sustaining needed links with outside organizations. Success with each care engagement is likely to depend upon how well all of these features are brought together. In a word, Organizational Coordination will determine how well the services of the home will be brought to the client.
Personal Coordination: This function is the complement to Organizational Coordination. In a similar manner to organizational preparation, the client needs to approach care fully prepared for success. This only will occur if key information and key supports are available for the client.