Why Integrated Care?
A common concern

According to surveys done by the Centers for Disease Control, nearly one third of Americans report suffering some mental or emotional problem each month, including 10 percent who say their mental health was not good fourteen or more days a month.  The prevalence rate among Medicaid enrollees may be even higher.  A study of a Medicaid HMO in Colorado (Thomas, MR et al) found that 39% of adults had a psychiatric diagnosis and that their health care costs were significantly higher than adults without such a diagnosis.  In North Carolina, a recent Asheville study found that over 65% of PCP visits made by Medicaid patients involved a behavioral health issue.  Behavioral health issues affect a significant portion of North Carolinians - and our most vulnerable citizens are disproportionately affected.

Poor access to care

While many areas of North Carolina have high-quality providers of MH/DD/SA services, both public and private, these services are often not easily accessible, especially for our Medicaid and uninsured citizens.  As reform of our public health system has evolved, professionals have migrated from government employment to private practice.  Some providers no longer bill for Medicaid while others who did have failed financially.  In addition, MH/DD/SAS providers are not evenly distributed geographically -- a fifth of North Carolina counties are designated as mental healthcare provider shortage areas.  In January 2006, a study by the Sheps Center reported that, between 1999 and 2004, nearly two-thirds of North Carolina’s counties experienced a decline in psychiatrist supply or had no psychiatrists. In a 2009 “Report Card” on Mental Health Reform, the North Carolina Psychiatric Association asserted that, from 2003 to 2005, the patient/psychiatrist ratio worsened by 24.2%.  Increasingly, primary care providers (PCPs) are filling unmet behavioral health needs.

Poor coordination of care

Coordination of physical and behavioral health care is also a concern.  Public behavioral health services are targeted at the most severely and persistently mentally ill and operate in a system that runs parallel and outside the general medical community.  Although the general population often uses their primary care provider or the Emergency Department for acute care, PCPs are poorly equipped and uncomfortable screening for, diagnosing and managing many of the behavioral health problems that present to them.  Citizens who primarily seek care from MH/DD/SAS providers may have physical health care needs that go unaddressed.  Systems for referral between physical and behavioral healthcare professionals are cumbersome and there is little sharing of healthcare information.

Reattaching the head to the body

The disconnection between physical and behavioral healthcare stems from a number of factors.  Historically, a separation occurred because the biological basis of mental health disorders was poorly understood and no medical treatments were available.  Behavioral health conditions were thought of as social, rather than medical, and persons needing MH/DD/SA services were often thought to be intellectually or morally inferior. As services for these conditions developed, separate organizational and funding structures evolved. Many have recognized the need to “reattach the head to the body”, but despite frequent calls for the integration of healthcare, significant barriers make this goal a challenge.  The ICARE Partnership is committed to overcoming these barriers and creating a healthcare system that is Integrated, Collaborative, Accessible, Respectful, and Evidence-based.

ICARE 101 - An overview of integrated care

Follow this link for the 2010 presentation, "NC Center of Excellence for Integrated Care: A Resource for Practice Change" by Regina Schaaf Dickens, Ed.D, ACSW, LCSW; Director, ICARE/NC Center of Excellence.

Additional information on integrated care is presented in "Trends in Children's Mental Health: Public Health Implications" by Jane Meschan Foy, MD, and "Integrating Behavioral Health into Primary Care: The Experiences of an FQHC in Eastern North Carolina."