The North Carolina Foundation for Advanced Health Programs
NC Center of Excellence for Integrated Care

The Center of Excellence for Integrated Care, a program of the NC Foundation for Advanced Health Programs, trains and supports healthcare providers to improve the quality of care for patients seen across the health system. The Center is an expert resource for the support of health care providers in the integration of medical care with behavioral health (mental health) care. The North Carolina Center of Excellence for Integrated Care builds on the work of a Foundation-sponsored program, The ICARE Partnership, which pioneered the integration of care in primary care practices between 2006 and 2010 through a broad inter-agency, multi-disciplinary partnership.

According to the US Centers for Disease Control, nearly one-third of Americans report suffering some mental or emotional problem each month. Many patients have both medical and behavioral health conditions, and both need to be addressed in order to help patients manage their health and improve the quality of their lives. Fifty percent of all outpatient care in the US is provided in primary care offices, and 67% of all psychoactive medications are prescribed by primary care providers (C.J. Peek, 2003). Forty percent of patients seen in primary care offices present with somatic complaints that may have their origin in psycho-social issues (Kroenke and Margelsdorff, 1989). The National Association of Mental Health Program Directors October 2006 report, “Morbidity and Mortality in People with Serious Mental Illness,” showed that life expectancy for patients with serious mental illness was 25 years less than that of the general US population. Reimbursement changes that carved out mental health care contributed to a system already fragmented, splitting behavioral health care from medical care. For patients with both a behavioral health condition and a chronic medical condition, care is often uncoordinated, sometimes duplicated, with unnecessary emergency department visits, improper medication, and poor outcomes in quality of life and disease management.

Workforce shortages in primary care and outpatient behavioral health care, most severe in rural and low-income communities, exacerbate barriers for patients. Integrated care, provided by a team, detects threats and follows up on behavioral health conditions within a medical setting. In what is now known as bi-directional care, or reverse co-location, medical services are delivered within a behavioral health setting, which is especially helpful for patients with severe and persistent mental illness who may align more with their behavioral health provider than a medical provider. In either model, care is integrated, focused on the patient’s needs, and managed collaboratively according to practices that are evidence-based and patient-centered. The NC Center of Excellence for Integrated Care was established to integrate care not only in primary care, but in settings such as behavioral health practices, emergency departments, and other healthcare settings.

The Center operates with a small interdisciplinary team, bolstered by experts in medicine, behavioral health, emergency medicine, billing and coding, and health care management. Working with multiple stakeholders, the Center ensures that consistent, evidence-based standards of care are adopted across health care settings, so that patients receive best practices wherever they seek care.

“This innovative new center does precisely what we need to be doing in health care today," said Gov. Bev Perdue. "It will deliver better care and do so more efficiently."

The Center has been built on the work of the ICARE Partnership, which, between 2006 and 2010, helped North Carolina to become a national leader in integrated care delivered in primary practice settings. This broad coalition of medical and mental health providers and associations, state agencies and patient advocacy groups, including the North Carolina Academy of Family Physicians, the North Carolina Pediatric Society, The North Carolina Psychiatric Association, and the Southern Regional Area Health Education Center (AHEC), created and delivered an extensive package of training and technical assistance to help primary care providers continue to integrate medical and mental health care into their practices. ICARE partnered with the NC Office of Rural Health and Community Care to implement integrated care in pilot projects at practices across the state.

The Center of Excellence is home to education and clinical resources that support integrated care. On the website, an interactive NC map offers detailed contact information for medical and mental health resources by county. Posted on the site are printable and downloadable guidance to implementing integrated practice, including practice tools, billing and coding references, and relevant research. The site is also rich with links to online courses, podcasts, a statewide continuing education events calendar, and many other outside resources organized by topic. The Center also conducts educational webinars and regional trainings.