a standard framework for levels of integrated healthcare

A STANDARD FRAMEWORK FOR LEvELS OF

INTEGRATED HEALTHCARE AND UPDATE

THROUGHOUT THE DOCUMENT

mARcH 2013

Acknowledgements

A Review and Proposed Standard Framework for Levels of Integrated Healthcare was developed for the SAMHSA-HRSA Center for

Integrated Health Solutions with funds under grant number 1UR1SMO60319-01 from SAMHSA-HRSA US Department of Health

and Human Services The statements findings conclusions and recommendation are those of the author(s) and do not necessarshy

ily reflect the view of SAMHSA HRSA or the US Department of Health and Human Services

Special thanks to Bern Heath Jr PhD CEO Axis Health System Kathy Reynolds MSW ACSW Vice President of Health Integration

and Wellness Promotion National Council for Community Behavioral Healthcare and Pam Wise Romero PhD Chief Clinical Officer

Axis Health Systems and for authoring this document

sAmHsA-HRsA centeR FoR IntegRAted HeAltH solUtIons

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioshy

ral health services to better address the needs of individuals with mental health and substance use conditions whether seen in

specialty behavioral health or primary care provider settings CIHS is the first ldquonational homerdquo for information experts and other

resources dedicated to bidirectional integration of behavioral health and primary care

Jointly funded by the HHSSubstance Abuse and Mental Health Services Administration and the Health Resources and Services

Administration and run by the National Council for Community Behavioral Healthcare CIHS provides training and technical assisshy

tance to community behavioral health organizations that received Primary and Behavioral Health Care Integration grants as well

as to community health centers and other primary care and behavioral health organizations

CIHSrsquos wide array of training and technical assistance helps improve the effectiveness efficiency and sustainability of integrated

services which ultimately improves the health and wellness of individuals living with behavioral health disorders

1701 K Street NW Suite 400

Washington DC 20006

2026847457

integrationtheNationalCouncilorg

wwwintegrationsamhsagov

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders

SuggeSted Citation Heath B Wise Romero P and Reynolds K A Review and Proposed Standard Framework for Levels of Integrated Healthcare Washington DCSAMHSA-HRSA Center for Integrated Health Solutions March 2013

Ac

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ow

le

dg

em

en

ts

SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS 2

3 SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS

aBStRaCt Integration of healthcare is essential to improve the individualrsquos experience of care improve the health of the general

population and reduce per capita healthcare costs The term ldquointegrationrdquo is widely and inconsistently used to describe the bringshy

ing together of healthcare components Integration has been used to reference everything from consultation to colocation to a

setting of shared health values around treating the whole person with blurred professional boundaries There have been no fully

updated taxonomies to describe the levels of integration since the 1996 Doherty McDaniel and Baird article which initially proshy

posed five levels of integration Since this seminal issue brief and preliminary framework there have been many informal and local

adaptations However without a standard classification of integrated settings discussions of integration lack clarity and precision

and research cannot confidently examine discrete aspects of integration This issue brief reviews levels of integrated healthcare

and proposes a functional standard framework for classifying sites according to these levels

KeY WoRdS integration collaborative care mental health behavioral health collaboration healthcare

BAckgRoUnd Over the last several years as healthcare reform has taken a prominent national position and mental health and substance abuse

treatments have evolved an increasing number of articles have been written on collaboration and the integration of traditional

primary care and behavioral health practices (Butler Kane amp McAlpine 2008 Collins Hewson Munger amp Wade 2010 Funk

amp Ivbijaro 2008 Lopez Coleman-Beattie amp Sanchez 2008 Mauer 2006 2009 Mauer amp Jarvis 2010 Miller Kessler amp Peek

2011 Robinson amp Reiter 2007 Russell 2010) These articles have described a wide variety of collaborative co-located and

integrated service models

Developing a standard framework to describe integrated efforts is critical for meaningful dialogue about service design as well as

for research Until there is a way to reliably categorize integration implementations meaningful comparisons of implementations

or associated health outcomes cannot occur This point is made throughout the Miller et al 2011 paper which calls for a broader

ldquolexicon for the common terms and components for collaborative care so that research questions can be framed in a consistently

understood mannerrdquo (p 2) On the clinical side integrated care developers and implementers will benefit from recognizing the

characteristics of practice change that support evolving integration models Knowing what features of integrated healthcare impleshy

mentations lead to the most favorable and stable health outcomes will be an important contribution to the health field

A standard framework also contributes to the orderly evolution of national healthcare reform and aligns with the political and

service realities defined by Berwick Nolan and Whittington (2008) Integration is essential to achieving the triple aim of improved

experience of care improved health of populations and reduced per capita healthcare cost advocated by Berwick et al The lesshy

sons learned from a reliable comparison of models and implementations provide the best foundation to inform policy decisions on

the structure of more effective healthcare as care integration moves forward

levels oF IntegRAtIon Doherty McDaniel and Baird (1995 1996) proposed the first classification by level of Until there is a way to reliably collaboration and integration They proposed the five levels of primary care-behavioral

healthcare collaboration recognizing that collaboration and integration of care were categorize integration evolving and being communicated in wide-ranging ways Doherty et alrsquos classification

implementations meaningfulinvolved both the extent of the occurrence of collaboration and the capacity for colshy

laboration in the setting but they did not focus on specific interactions An underlying comparisons of implementationspremise of the levels was that as collaboration increased the adequate handling of

complex patients would also increase The levels recognized by Doherty et al did not or associated health outcomes prescribe a particular model as best for all healthcare settings but rather served as

a foundation from which to tease apart the strengths and limitations of a variety of cannot occur

sA

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ns

This issue brief uses the term behavioral health to describe mental health and substance use

SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS

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options It was proposed that use of the levels would help organizations evaluate their setting in light of their goals for collaboration

and to assist in researching outcomes and costs associated with different collaborative models with different patient populations

In the original framework Doherty et al differentiated levels by where they were practiced the cases adequately handled at each

level and the following descriptions

8 LeveL 1ndash Minimal Collaboration Mental health and other healthcare providers work in separate facilities have separate

systems and rarely communicate about cases

8 LeveL 2 ndash Basic Collaboration at a Distance Providers have separate systems at separate sites but engage in periodic

communication about shared patients mostly through telephone and letters Providers view each other as resources

8 LeveL 3 ndash Basic Collaboration Onsite Mental health and other healthcare professionals have separate systems but share

facilities Proximity supports at least occasional face-to- face meetings and communication improves and is more regular

8 LeveL 4 ndash Close Collaboration in a Partly Integrated System Mental health and other healthcare providers share the same

sites and have some systems in common such as scheduling or charting There are regular face-to-face interactions among

primary care and behavioral health providers coordinated treatment plans for difficult patients and a basic understanding

of each otherrsquos roles and cultures

8 LeveL 5 ndash Close Collaboration in a Fully Integrated System Mental health and other healthcare professionals share the

same sites vision and systems All providers are on the same team and have developed an in-depth understanding of

each otherrsquos roles and areas of expertise

The following chart summarizes these five levels of collaboration

MINIMAL COLLAbORATION

bASIC COLLAbORATION

FROM A DISTANCE

bASIC COLLAbORATION

ONSITE

CLOSE COLLAbORATION

PARTLy INTEGRATED

FULLy INTEGRATED

8 Separate systems

8 Separate facilities

8 Communication is

8 Separate systems


8 Periodic focused

8 Separate systems

8 Same facilities

8 Regular rare

8 Little appreciation of each otherrsquos culture

ldquoNobody knows my name Who are yourdquo

communication most written

8 View each other as outside resources

8 Little understandshying of each otherrsquos culture or sharing of influence

ldquoI help your consumersrdquo

communication occasionally face-to-face

8 Some appreciation of each otherrsquos role and general sense of large picture

8Mental health usually has more influence

ldquoI am your consultantrdquo

8Some shared systems

8Same facilities

8Face-to-Face consultation coordinated treatment plans

8Basic appreciation of each otherrsquos role and cultures

8Collaborative routines difficult time and operation barriers

8Influence sharing

ldquoWe are a team in the care of consumersrdquo

8Shared systems and facilities in seamless bio-psychosocial web

8Consumers and providers have same expectations of system(s)

8In-depth appreciation of roles and culture

8Collaborative routines are regular and smooth

8Conscious influence sharing based on situation and expertise

ldquoTogether we teach others how to be a team in care of conshysumers and design a care systemrdquo

4


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These five levels have formed the foundation for most subsequent level adaptations The idea that integration occurs along a

continuum of collaboration and integration is widely supported (Collins et al 2010 Miller et al 2011 Peek 2007 Reynolds

2006 Seaburn Lorenz Gunn Gawinski amp Mauksch 1996 Strohsal 1998) and adaptations have differed in the number of levels

(from three to 10) and the categories used to differentiate or describe levels

The reason for classification whether for clinical development or research

has influenced the choice of dimensions used to define each level For

example Reynolds (2006) used the same five levels but distinguishes

between levels on the basis of functional practice categories including

access services funding governance evidence-based practice and

data usage The goal of Reynoldsrsquo adaptation is to better capture the pashy

tient and staff experience at the different levels in doing so it broadens

the levelsrsquo descriptions and characteristics

Other papers and reports have classified integrated implementations

somewhat differently MaineHealth (2009) developed a site-specific ratshy

ing of integration that has four levels along a continuum of integration

with one rating in the first level and three ratings in levels two three and four There are 18 characteristics broadly categorized

as integrated services patient- and family-centeredness and practiceorganization In the first category characteristics such as

colocation patientfamily involvement and communication with patients about integrated care are rated In the second category

characteristics such as organizational leadership for integrated care providersrsquo engagement and data systemspatient are rated

More similar to Doherty et al Blount (2003) collapsed the five levels to three coordinated co-located and integrated care Reshy

cent work to develop a lexicon or common conceptual system for collaborative care between behavioral health and primary medical

clinicians (Miller et al 2011) has also adopted these three levels in describing collaborative care practice

The Milbank report Evolving Models of Behavioral Health Integration in Primary Care (Collins et al 2010) describes eight models

of integration across a variety of settings This group uses Doherty et alrsquos five level structure and the terms coordinated co-

located and integrated to differentiate these models

PRoPosed stAndARd FRAmewoRk Doherty et al established the five levels of integration recognizing differences in integrated implementations and the various forms

collaboration took in each level Based upon the initial efforts by Doherty et al and the experience accumulated over the intervenshy

ing 17 years the authors of this paper propose a new version of the levels of collaborationintegration The proposed framework

brings together valuable aspects that have evolved since the Doherty et al paper The proposed framework also includes several

enhancements that enable it to be comprehensive enough to serve as a national standard for future discussion about integrated

healthcare allow organizations implementing integration to gauge their degree of integration against acknowledged benchmarks

and serve as a foundation for comparing healthcare outcomes between integration levels

Doherty et al established the concept of levels of implementations that followed a continuum from collaboration to integration The

proposed model in this issue brief retains some of the original categorical descriptions that continue to prove useful today Blountrsquos

use of coordination colocation and integration serve as overarching categories The Milbank report which brought together

Doherty et alrsquos five levels and Blountrsquos broader categories also informs this conceptual framework

This new level of integration framework proposes six levels of collaborationintegration While the overarching framework has three

main categories mdash coordinated co-located and integrated care mdash there are two levels of degree within each category (see Table

1) It is designed to help organizations implementing integration to evaluate their degree of integration across several levels and to

determine what next steps they may want to take to enhance their integration initiatives

Coordinated Care

8 LeveL 1 mdash Minimal Collaboration

Behavioral health and primary care providers work at separate facilities and have separate systems Providers communicate

rarely about cases When communication occurs it is usually based on a particular providerrsquos need for specific information

about a mutual patient

8 LeveL 2 mdash Basic Collaboration at a Distance

Behavioral health and primary care providers maintain separate facilities and separate systems Providers view each other

as resources and communicate periodically about shared patients These communications are typically driven by specific

issues For example a primary care physician may request copy of a psychiatric evaluation to know if there is a confirmed

psychiatric diagnosis Behavioral health is most often viewed as specialty care

Co-Located Care

8 LeveL 3 mdash Basic Collaboration Onsite

Behavioral health and primary care providers co-located in the same facility but may or may not share the same practice

space Providers still use separate systems but communication becomes more regular due to close proximity especially

by phone or email with an occasional meeting to discuss shared patients Movement of patients between practices is

most often through a referral process that has a higher likelihood of success because the practices are in the same locashy

tion Providers may feel like they are part of a larger team but the team and how it operates are not clearly defined leaving

most decisions about patient care to be done independently by individual providers

8 LeveL 4 mdash Close Collaboration with Some System Integration

There is closer collaboration among primary care and behavioral healthcare providers due to colocation in the same

practice space and there is the beginning of integration in care through some shared systems A typical model may

involve a primary care setting embedding a behavioral health provider In an embedded practice the primary care front

desk schedules all appointments and the behavioral health provider has access and enters notes in the medical record

Often complex patients with multiple healthcare issues drive the need for consultation which is done through personal

communication As professionals have more opportunity to share patients they have a better basic understanding of each

otherrsquos roles

Integrated Care

8 LeveL 5 mdash Close Collaboration Approaching an Integrated Practice

There are high levels of collaboration and integration between behavioral and primary care providers The providers begin

to function as a true team with frequent personal communication The team actively seeks system solutions as they recogshy

nize barriers to care integration for a broader range of patients However some issues like the availability of an integrated

medical record may not be readily resolved Providers understand the different roles team members need to play and they

have started to change their practice and the structure of care to better achieve patient goals

8 LeveL 6 mdash Full Collaboration in a TransformedMerged Practice

The highest level of integration involves the greatest amount of practice change Fuller collaboration between providers

has allowed antecedent system cultures (whether from two separate systems or from one evolving system) to blur into a

single transformed or merged practice Providers and patients view the operation as a single health system treating the

whole person The principle of treating the whole person is applied to all patients not just targeted groups

Key elements were added to more clearly differentiate between the levels in each overarching category For coordinated care

the key element is communication The distinction between Level 1 and Level 2 is frequency and type of communication With inshy

creased communication providers have stronger relationships and greater understanding of the importance of integrated care and

sA

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the skills that different providers possess This communication increases

the coordination of care between separate healthcare entities

Physical proximity is the key element for the co-located care category

Although colocation does not guarantee greater collaboration or integrashy

tion it can be beneficial Taking advantage of close proximity increases

collaboration through face-to-face contact at Level 3 It can also develop

the opportunity for trust and relationship building leading to more sharing

of systems mdash the hallmark of beginning integration at Level 4 However

providers can be co-located and have no integration of their healthcare

services Each provider can still practice independently without commushy

nicating with others and with an integrated healthcare plan Colocation

reduces time spent travelling from one practitioner to another but does not guarantee integration

At Level 5 and Level 6 practice change is the key element No site can be fully integrated without changing how both behavioral

health and primary care are practiced The requisite practice change features a blending or blurring of cultures where no one disshy

cipline predominates Across many integrated implementations at several levels almost every practitioner wants integrated care

and believes it is the direction for healthcare to move towards until they realize it requires they change how they practice It is at

that point they often try to change the concepts of their integration efforts to preserve how they currently practice

A second modification proposed to the original Doherty et al structure is the use of the terms ldquocollaborationrdquo and ldquointegrationrdquo In

this framework collaboration describes how resources mdash namely the healthcare professionals mdash are brought together integration

describes how services are delivered and practices are organized and managed This idea is similar to Strosahlrsquos (1998) concept

that collaborative care involves behavioral health working with primary care while integration is behavioral health working within

and as part of primary care Recent analysis (Mauer amp Jarvis 2010) indicates that collaboration and integration can effectively

originate in either behavioral health or primary care and requires the transformation of both into a single whole In this standard

framework both collaboration and integration (beginning at Level 3) increase in degree and complexity over the continuum for

providers while similarly decreasing for clientsindividuals

An important enhancement to the levels is also found in a restructuring of the descriptive characteristics defining each level (see

Table 1) Each of the six levels begins with a general description followed by key differentiators (see Table 2A and 2B) under the

headings clinical delivery patient experience practiceorganization and business model These characteristics help differentiate

the levels They also incorporate some of the functional categories Reynolds (2006) identified in her consumerstaff experiential

perspective of the levels of integration Kodnerrsquos (2009) integrated care domains and MaineHealthrsquos (2009) Site Assessment

Finally Table 3 describes the strengths and weaknesses of each level so that these can be built upon or addressed

Although the term behavioral health has been used throughout this proposed framework integration of substance use treatment

and primary care has not been as extensive or prevalent as integration of mental health with primary care Further work is required

to more effectively support substance use integration (Butler et al 2008 Mauer 2010)

It is worth noting that even if health outcomes improve as levels of integration increase it is not reasonable to believe that all

healthcare settings would be able to easily or even with difficulty move to increasing levels of integration As primary care and

behavioral health have evolved in their own professional silos it has been the authorsrsquo experience that the bringing together of

these services and service perspectives (usually embodied in separate agencies) into a single fully integrated healthcare system

requires a large amount of administrative political and financial investments over a long-term stepwise evolutionary process It

is important to aspire to whichever level can be best achieved practically

At Level 3 colocation may be a necessary and good starting point to build trust between separate existing systems and to estabshy

lish a shared history of improved outcomes This could lead to closer collaboration and integration of vision that moves to Level

4 implementation possibly leading from there to a Level 5 partnership Such a partnership may be the highest level attainable or

may in years to come lead to a joint venture or a merger of the organizations While this has not been fully researched merging

primary and behavioral health organizations appears necessary at this point for achieving Level 6 integration


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From a data standpoint this framework also posits that integrated services should be defined by location not by an algorithm of

service code combinations A single service (eg blood pressure check or depression medication check) provided in an integrated

sitesetting is considered an integrated service because it is provided in the context of that integrated sitersquos whole person care

Conversely multiple services provided in a single visit are not by definition integrated care these services could be and all too

often are provided by separate professionals without meaningful collaboration or integration By defining the level of integration

in terms of setting the authors of this framework define the context of interventions and the values (eg care team whole health

patient-centered) that form the basis of an integrated site and integrated services The key performance indicators in an integrated

care setting are population-based health status outcomes not encounter-based processservice data Individual staff productivity

must accompany and then be replaced by population-based outcomes by site

Funding structures and accountability must also change Integrated care is not supported by fee-for-service funding structures

that stumble over same day billing restrictions and do not reimburse for consultations between providers when the patient is not

physically present or electronic contacts or a large volume of care management mdash all of which are essential for improved health

outcomes in an integrated healthcare system Fee-for-service funding can emphasize the measurement of volume rather than

quality Global or blended funding structures do support integrated healthcare and will be fiscally justified by improved patient

outcomes that reduce overall healthcare cost

conclUsIon The proposed level of integration framework is a manageable practical and conceptually sound six level framework for integrated

healthcare that begins with collaboration (how resources are brought together) and moves through colocation and increasing levels

of integration (how services are framed and delivered) This standard framework is needed for clarity and precision of communicashy

tion as well as to contribute to research and practice redesign By implication the numbering of levels suggests that the higher

the level of collaborationintegration the more potential for positive impact on health outcomes and patient experience This belief

remains a hypothesis and has not been empirically tested With further research these benefits of collaborationintegration can

be more firmly stated and can identify which aspects of the collaboration integration or combination of the two contribute most

directly to health outcomes

Even if health outcomes improve as levels of integration increase it is not practical to believe that every healthcare setting will be

able at least in the near term to implement increasing levels of integration Many integrated implementations will be constrained

by community politics trust between organizational systems financing andor differing service values

Lastly this issue brief does not presume to establish a fuller lexicon for integration and healthcare as much needed as it is The

authors leave that to others better suited to the task and hope that this paper will contribute to such a lexicon The purpose is

to help those delivering services today by presenting a conceptual framework to better understand and differentiate integrated

healthcare implementations The authors believe that this framework will inform discussions about integrated healthcare and that

its use will provide opportunity for service redesign that will lead to better conceptual and practical models of care


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ReFeRences

Berwick DM Nolan TW amp Whittington J (2008) The triple aim Care health and cost Health Affairs 27(3) 759-769

Blount A (2003) Integrated primary care Organizing the evidence Families Systems amp Health 21 (2) 121-33 doi 1010371091shy75272121121

Blount A (Ed) (1998) Integrated primary care The future of medical and mental health collaboration New York Norton

Butler M Kane RL McAlpine D et al Integration of Mental HealthSubstance Abuse and Primary Care No 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No 290-02-0009) AHRQ Publication No 09-E003 Rockville MD Agency for Healthcare Research and Quality October 2008

Collins C Hewson DL Munger R amp Wade T (2010) Evolving models of behavioral health Integration in primary care Report commissioned by the Milbank Memorial Fund

Doherty W (1995) The whyrsquos and levels of collaborative family health care Family Systems Medicine 13(3-4) 275-81 doi101037h0089174

Doherty WJ McDaniel SH amp Baird MA (1996) Five levels of primary carebehavioral healthcare collaboration Behavioral Healthcare Tomorrow 25-28

Funk M and G Ivbijaro eds (2008) Integrating mental health into primary care ndash A global perspective Geneva Switzerland World Health Organization and London UK World Organization of Family Doctors Available at wwwwhointmental_healthpolicyMental20health20+20primary20care-20final20low-res20140908pdf

Kodner Dennis (2009) All together now A conceptual exploration of integrated care Healthcare Quarterly 13 (Sp) 6-15

Lopez M B Coleman-Beattie L Jahnke and K Sanchez (2008) Connecting body and mind A resource guide to integrated health care in Texas and the United States Austin TX Hogg Foundation for Mental Health

Mauer B (2006) Behavioral healthprimary care integration The four quadrant model and evidence-based practices Rockville MD National Council for Community Behavioral Healthcare

Mauer B (2009) Behavioral healthprimary care integration and the person-centered healthcare home Washington DC National Council for Community Behavioral Healthcare

Mauer B (2010) Substance use disorders and the person-centered healthcare home Rockville MD National Council for Community Behavioral Healthcare

Mauer B amp Jarvis D (2010) The business case for bidirectional integrated care Mental health and substance use services in primary care settings and primary care services in specialty mental health and substance use settings Integration Policy Initiative

Maine Health Access Foundation (2009) Site Self-Assessment

Miller BF Kessler R Peek CJ (2011) A national agenda for research in collaborative care Papers from the Collaborative Care Research Network Research Development Conference AHRQ Publication No 11-0067 Rockville MD Agency for Healthcare Research and Quality

Peek CJ (2007) Integrated Care Aids to Navigation Study packet for the Pennsylvania Eastern Ohio amp West Virginia Summit Integrating Mental Health and Primary Care Pittsburgh PA

Reynolds K (2006) Mental Health Primary Care Integration Options (Unpublished document)

Robinson PJ amp Reiter JT (2007) Behavioral consultation and primary care A guide to integrating services New York Springer

Russell L (2010) Mental health care services in primary care Tackling the issues in the context of health care reform Center for American Progress Washington DC

Seaburn Lorenz Gunn Gawinksi amp Mauksch (1996) Models of collaboration A guide for mental health professionals working with health care practitioners Basic Books

Strosahl K (1998) Integrating behavioral health and primary care services The primary mental health care model In Integrated primary care The future of medical and mental health collaboration edited by A Blount pp 139-66 New York WW Norton

Strosahl K amp Robinson P (2008) The primary care behavioral health model Applications to prevention acute care and chronic condition management In R Kessler amp D Strafford (Eds) Collaborative medicine case studies Evidence in practice New York Springer


SA

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-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy

n eti amli s c ya il ey

e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t

am acn s eyr hI s p t

e n m e i o rh est

y ( hi

e w ti wl )c i eca cap

e f a

e s p

mm a d s

e ae

sn

s reyh ha hI t s t 8Ac

tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13

Acknowledgements

A Review and Proposed Standard Framework for Levels of Integrated Healthcare was developed for the SAMHSA-HRSA Center for

Integrated Health Solutions with funds under grant number 1UR1SMO60319-01 from SAMHSA-HRSA US Department of Health

and Human Services The statements findings conclusions and recommendation are those of the author(s) and do not necessarshy

ily reflect the view of SAMHSA HRSA or the US Department of Health and Human Services

Special thanks to Bern Heath Jr PhD CEO Axis Health System Kathy Reynolds MSW ACSW Vice President of Health Integration

and Wellness Promotion National Council for Community Behavioral Healthcare and Pam Wise Romero PhD Chief Clinical Officer

Axis Health Systems and for authoring this document

sAmHsA-HRsA centeR FoR IntegRAted HeAltH solUtIons

The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioshy

ral health services to better address the needs of individuals with mental health and substance use conditions whether seen in

specialty behavioral health or primary care provider settings CIHS is the first ldquonational homerdquo for information experts and other

resources dedicated to bidirectional integration of behavioral health and primary care

Jointly funded by the HHSSubstance Abuse and Mental Health Services Administration and the Health Resources and Services

Administration and run by the National Council for Community Behavioral Healthcare CIHS provides training and technical assisshy

tance to community behavioral health organizations that received Primary and Behavioral Health Care Integration grants as well

as to community health centers and other primary care and behavioral health organizations

CIHSrsquos wide array of training and technical assistance helps improve the effectiveness efficiency and sustainability of integrated

services which ultimately improves the health and wellness of individuals living with behavioral health disorders

1701 K Street NW Suite 400

Washington DC 20006

2026847457

integrationtheNationalCouncilorg

wwwintegrationsamhsagov

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders

SuggeSted Citation Heath B Wise Romero P and Reynolds K A Review and Proposed Standard Framework for Levels of Integrated Healthcare Washington DCSAMHSA-HRSA Center for Integrated Health Solutions March 2013

Ac

kn

ow

le

dg

em

en

ts





































sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

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so

lU

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ns



SA

MH

SA

-HR

SA

Ce

nt

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eg

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bASIC COLLAbORATION

FROM A DISTANCE

bASIC COLLAbORATION

ONSITE

CLOSE COLLAbORATION

PARTLy INTEGRATED

FULLy INTEGRATED

8 Separate systems


8 Communication is

8 Separate systems


8 Periodic focused

8 Separate systems

8 Same facilities

8 Regular rare












8Same facilities




8Influence sharing








4


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS









































Coordinated Care










Co-Located Care















otherrsquos roles

Integrated Care















sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

ltH

so

lU

tIo

ns



SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS















































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13




































sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

ltH

so

lU

tIo

ns



SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS




















bASIC COLLAbORATION

FROM A DISTANCE

bASIC COLLAbORATION

ONSITE

CLOSE COLLAbORATION

PARTLy INTEGRATED

FULLy INTEGRATED

8 Separate systems


8 Communication is

8 Separate systems


8 Periodic focused

8 Separate systems

8 Same facilities

8 Regular rare












8Same facilities




8Influence sharing








4


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS









































Coordinated Care










Co-Located Care















otherrsquos roles

Integrated Care















sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

ltH

so

lU

tIo

ns



SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS















































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS




















bASIC COLLAbORATION

FROM A DISTANCE

bASIC COLLAbORATION

ONSITE

CLOSE COLLAbORATION

PARTLy INTEGRATED

FULLy INTEGRATED

8 Separate systems


8 Communication is

8 Separate systems


8 Periodic focused

8 Separate systems

8 Same facilities

8 Regular rare












8Same facilities




8Influence sharing








4


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS









































Coordinated Care










Co-Located Care















otherrsquos roles

Integrated Care















sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

ltH

so

lU

tIo

ns



SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS















































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

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SA

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nt

eR

fo

R I

nt

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te

d H

eA

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sA

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eR

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R I

nt

eg

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eA

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SA

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SA

MH

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eR

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SA

MH

SA

-HR

SA

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nt

eR

fo

R I

nt

eg

RA

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eA

ltH

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lu

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ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13

Coordinated Care










Co-Located Care















otherrsquos roles

Integrated Care















sA

mH

sA

-HR

sA

ce

nt

eR

Fo

R I

nt

eg

RA

te

d H

eA

ltH

so

lU

tIo

ns



SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS















































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS















































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

































SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

ReFeRences

























SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 1

Six

Lev

els

of C

olla

bo

ratio

nIn

tegr

atio

n (C

ore

Des

crip

tions

)

CO

OR

DIN

AT

ED

KE

y E

LEM

EN

T C

OM

MU

NIC

AT

ION

CO

LO

CA

TE

D

KE

y E

LEM

EN

T P

Hy

SIC

AL

PR

Ox

IMIT

y

INT

EG

RA

TE

D

KE

y E

LEM

EN

T P

RA

CT

ICE

CH

AN

GE

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

beh

avio

ral h

ealt

h p

rim

ary

care

an

d o

ther

hea

lth

care

pro

vid

ers

wo

rk

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

Com

mun

icat

e ab

out c

ases

on

ly ra

rely

and

und

erco

mpe

lling

circ

umst

ance

s

8 8 C

omm

unic

ate

driv

en b

y pr

ovid

er n

eed

8 M

ay n

ever

mee

t in

pers

on

8 H

ave

limite

d un

ders

tand

shyin

g of

eac

h ot

herrsquos

role

s

In s

epar

ate

faci

litie

swh

ere

they

8 H

ave

sepa

rate

sys

tem

s

8Co

mm

unic

ate

perio

dica

llyab

out s

hare

d pa

tient

s

8 C

omm

unic

ate

driv

en b

y sp

ecifi

c pa

tient

issu

es

8 M

ay m

eet a

s pa

rt of

larg

er

com

mun

ity

8Ap

prec

iate

eac

h ot

herrsquos

ro

les

as re

sour

ces

secfi t f

o oy


e f ar h

m ss e t

a e r

n s ece hI n w 8

Hav

e se

para

te s

yste

ms

8 C

omm

unic

ate

regu

larly

ab

out s

hare

d pa

tient

s b

y ph

one

or e

-mai

l

8 C

olla

bora

te d

riven

by

need

for e

ach

othe

rrsquos

serv

ices

and

mor

e re

liabl

e re

ferra

l

8M

eet o

ccas

iona

lly to

disc

uss

case

s du

e to

clo

sepr

oxim

ity

8 F

eel p

art o

f a la

rger

yet

no

n-fo

rmal

team

e h ey

n t h

ih e t

rti ee

w hc wya tp il

e s ica

ma e f

n s maI s 8

Sha

re s

ome

syst

ems

like

sc

hedu

ling

or m

edic

alre

cord

s

8Co

mm

unic

ate

in p

erso

nas

nee

ded

8 C

olla

bora

te d

riven

by

need

for c

onsu

ltatio

n an

dco

ordi

nate

d pl

ans

for

diffi

cult

patie

nts

8 H

ave

regu

lar f

ace-

to-fa

ce

inte

ract

ions

abo

ut s

ome

patie

nts

8 H

ave

a ba

sic

unde

rsta

ndin

g of

role

san

d cu

lture

e h all

n t erih in

gt hei ar

e w h w

s ec ya t acp ili p

e s c sa e

m f icea t


e n m e i o rh est

y ( hi


e f a

e s p

mm a d s

e ae

sn


tivel

y se

ek s

yste

m

solu

tions

toge

ther

or

deve

lop

work

-a-ro

unds

8Co

mm

unic

ate

frequ

ently

in p

erso

n

8 C

olla

bora

te d

riven

by

desi

re to

be

a m

embe

r of

the

care

team

8 H

ave

regu

lar t

eam

m

eetin

gs to

dis

cuss

ove

rall

patie

nt c

are

and

spec

ific

patie

nt is

sues

8 H

ave

an in

-dep

th u

nshyde

rsta

ndin

g of

role

s an

dcu

lture

8 H

ave

reso

lved

mos

t or a

ll sy

stem

issu

es f

unct

ioni

ng

as o

ne in

tegr

ated

sys

tem

8Co

mm

unic

ate

cons

iste

ntly

at th

e sy

stem

tea

m a

nd

indi

vidu

al le

vels

8 C

olla

bora

te d

riven

by

shar

ed c

once

pt o

f tea

mca

re

8 H

ave

form

al a

nd in

form

al

mee

tings

to s

uppo

rt in

tegr

ated

mod

el o

f car

e

8 H

ave

role

s an

d cu

lture

s th

at b

lur o

r ble

nd

10


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 2

A S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Clin

ical

Del

iver

y

Scr

eeni

ng a

nd a

sses

sshym

ent d

one

acco

rdin

g to

se

para

te p

ract

ice

mod

els

Sepa

rate

trea

tmen

t pla

ns

Ev

iden

ced-

base

d pr

actic

es (E

BP)

impl

emen

ted

sepa

rate

ly

8 8 8

Scre

enin

g ba

sed

on

sepa

rate

pra

ctic

es m

al

y be

mat

ion

ma

info

rsh

ared

thro

ugh

for

requ

ests

or H

ealth

m

atio

n Ex

chan

ges

Info

r

Sepa

rate

trea

tmen

t pl

ans

shar

ed b

ased

on

esta

blis

hed

rela

tion-

een

spec

ific

ship

s be

twvi

ders

pr

o

Sepa

rate

resp

onsi

bilit

y fo

r car

eEB

Ps

8 8 8

ree

on a

spe

cific

y

ag M

a

crite

ria fo

r mor

e ef

fect

ive

sc

reen

ing

or o

ther

ral

vice

pla

ns

ms e

in-h

ouse

refe

r

Sep

arat

e se

rwi

th s

ome

shar

ed

mat

ion

that

info

r

wled

g

info

rth

em

8

Som

e sh

ared

kno

s EB

Ps

of e

ach

othe

rrsquoes

peci

ally

for h

igh

utili

zers

88

A

gree

on

spec

ific

bas

ed o

n sc

reen

ing

abili

ty to

resp

ond

to

e tre

atm

ent

resu

lts

8

Col

labo

rativ

plan

ning

for s

peci

fic

patie

nts

Som

e EB

Ps a

nd s

ome

focu

sed

train

ing

shar

ed

on in

tere

st o

r spe

cific

po

pula

tion

need

s

8 8

Con

sist

ent s

et o

f agr

eed

upon

scr

eeni

ngs

acro

ss

disc

iplin

es w

hich

gui

de

vent

ions

e tre

atm

ent

treat

men

t int

er

8

Col

labo

rativ

plan

ning

for a

ll sh

ared

patie

nts

8

EBP

s sh

ared

acr

oss

sys-

tem

with

som

e jo

int m

onishy

torin

g of

hea

lth c

ondi

tions

fo

r som

e pa

tient

s

8

8 P

opul

atio

n-ba

sed

m

edic

al a

nd b

ehav

iora

l he

alth

scr

eeni

ng is

stan

dard

pra

ctic

e wi

thre

sults

ava

ilabl

e to

all

and

resp

onse

pro

toco

lsin

pla

ce

8On

e tre

atm

ent p

lan

for a

llpa

tient

s

8EB

Ps a

re te

am s

elec

ted

train

ed a

nd im

plem

ente

dac

ross

dis

cipl

ines

as

stan

dard

pra

ctic

e

Key

Dif

fere

ntia

tor

Pat

ien

t Exp

erie

nce

ysic

al a

nd b

eshy P

atie

nt p

hha

vior

al h

ealth

nee

ds a

re

treat

ed a

s se

para

te is

sues

otia

te

Pat

ient

mus

t neg

sepa

rate

pra

ctic

es a

nd

wn w

ith

rees

of s

ucce

ss

site

s on

thei

r oyi

ng d

egarv

8 8vi

der

P

atie

nt h

ealth

nee

ds

are

treat

ed s

epar

atel

ybu

t rec

ords

are

sha

red re

d

prom

otin

g be

tter p

ro riers

y

be re

fer

y pa

tient

s

e

arie

ty o

f bar

wled

gkn

o

Pat

ient

s m

abu

t a v

vent

man

pre

from

acc

essi

ng c

are

8 8

atie

nt h

ealth

nee

ds a

re y

y b

ws

P treat

ed s

epar

atel

y at

the

sam

e lo

catio

n

8

Clo

se p

roxim

ity a

llora

ls to

be

mor

e re

fer

succ

essf

ul a

nd e

asie

r for

ho

a

lthou

gh w ar

y v

red

ma

patie

nts

gets

refe

rvi

der

pro

8

col

labo

ratio

n m

ight

Pat

ient

nee

ds a

re tr

eate

d se

para

tely

at t

he s

ame

m h

and-

offs

to

vide

rs

site

in

clud

e wa

rot

her t

reat

men

t pro na

lly

Pat

ient

s ar

e in

ter

red

with

bet

ter f

ollo

wshyre

fer

up b

ut c

olla

bora

tion

may

st

ill b

e ex

perie

nced

as

vice

s se

para

te s

er

8 8

y

e on

Pat

ient

nee

ds a

re tr

eate

d as

a te

am fo

r sha

red

patie

nts

(for t

hose

wh

o sc

reen

pos

itiv

scre

enin

g m

easu

res)

and

sepa

rate

ly fo

r oth

ers

e to

8

Car

e is

resp

onsi

vid

entifi

ed p

atie

nt n

eeds

bvi

ders

as e a

of a

team

of p

ro w

hich

feel

s lik

need

ed

one-

stop

sho

p

8

All p

atie

nt h

ealth

nee

ds ar

e tre

ated

for a

ll pa

tient

sby

a te

am w

ho fu

nctio

n et

her

ely

tog

effe

ctiv

Pat

ient

s ex

perie

nce

a se

amle

ss re

spon

se to

all h

ealth

care

nee

ds a

s in

a u

nifie

d y

pres

ent

the

prac

tice

8 8

11


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

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lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

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ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

No

coo

rdin

atio

n or

ts

em

ent o

f e

effo

r

vide

r buy

-in

en

ratio

n or

ev

up

to

vide

rs to

man

agco

llabo

rativ

Litt

le p

roto

inte

gco

llabo

ratio

nin

divi

dual

pro

initi

ate

as ti

me

and

prac

tice

limits

allo

w

8 8

Som

e pr

actic

e le

ader

shysh

ip in

mor

e sy

stem

atic

vide

r buy

-into

al

ue

ving

nee

ded

mat

ion

shar

ing

info

r

Som

e pr

oco

llabo

ratio

n an

d v

plac

ed o

n ha

mat

ion

info

r

8 8

Org

aniza

tion

lead

ers

tive

but o

ften

colo

shysu

ppor

catio

n is

vie

wed

as

a pr

ojec

t or p

rogr

am ork

and

vide

r buy

-in to

ra

ls w

Pro mak

ing

refe

rap

prec

iatio

n of

ons

ite

vaila

bilit

y a

8 8

thro

ugh

mut

ual p

robl

em-

Org

aniza

tion

lead

ers

ratio

n t i

nteg

supp

or

solv

ing

of s

ome

syst

em

riers

ba

r

Mor

e bu

y-in

to c

once

pt

vide

rs

ratio

n bu

t not

of

inte

gco

nsis

tent

acr

oss

not

all

pro

tuni

ties

for

vide

rs

pro

usin

g op

por

inte

grat

ion

or c

ompo

nent

s

8 8

ts

w

Org

aniza

tion

lead

ers if

ra

tion

ws a

nd e

ffor

t int

egsu

ppor

fund

ing

allo

plac

ed in

sol

ving

as

man

y sy

stem

issu

es a

s w

ithou

t cha

ngshy

poss

ible

in

g fu

ndam

enta

lly h

odi

scip

lines

are

pra

ctic

ed

rate

d y

not

vide

rs

e in

pra

ctic

e

ly a

ll pr

o N

ear ag

ed in

inte

g B

uy-in

ma

y fo

r ind

ivid

ual

eng

mod

el

incl

ude

chan

g

vide

rs

stra

teg

pro

8 8

y e

ervi

ded

aniza

tion

lead

ers

t ra

tion

as p

ract

ice

Org

stro

ngly

sup

por

inte

gm

odel

with

exp

ecte

dvi

ce d

eliv

e in

ser

chan

g

for d

evel

opm

ent

rate

d ca

re a

nd a

ll In

teg

com

pone

nts

embr

aced

vide

rs a

nd a

ctiv

and

reso

urce

s pr

o

by a

ll pr

ool

vem

ent i

n pr

actic

e e

vin ch

ang

8 8

Tab

le 2

b S

ix L

evel

s o

f Co

llab

ora

tion

Inte

grat

ion

(Key

Diff

eren

tiato

rs c

ont

inue

d)

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Key

Dif

fere

ntia

tor

Pra

ctic

eO

rgan

izat

ion

Key

Dif

fere

ntia

tor

bu

sin

ess

Mo

del

Se

para

te fu

ndin

g

No s

harin

g of

reso

urce

s

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re re

sour

ces

for

sing

le p

roje

cts

Sepa

rate

bill

ing

prac

tices

8 8 8

Sepa

rate

fund

ing

May

sha

re fa

cilit

y ex

pens

es

Sepa

rate

bill

ing

prac

tices

8 8 8

but

may

S

epar

ate

fund

ing

rant

s sta

ffing

cos

ts

shar

e g

y sh

are

offic

e

uctu

re

Ma

expe

nses

or

infra

str

Sepa

rate

bill

ing

due

to

riers

sy

stem

bar

8 8 8

Bl

ende

d fu

ndin

g ba

sed

uctu

re

on c

ontra

cts

gra

nts

or

ys to

str

agre

emen

ts

Varie

ty o

f wa

8

the

shar

ing

of a

ll ex

pens

es

Billi

ng fu

nctio

n co

mbi

ned

reed

upo

n pr

oces

s or

ag

8 8

8 8Re

sour

ces

shar

ed a

nd

hole

rate

d fu

ndin

g In

teg

base

d on

mul

tiple

sour

ces

of re

venu

e

allo

cate

d ac

ross

wpr

actic

e

Billi

ng m

axim

ized

for

rate

d m

odel

and

uc

ture

in

teg

sing

le b

illin

g st

r

8

12


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

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llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13


SA

MH

SA

-HR

SA

Ce

nt

eR

fo

R I

nt

eg

RA

te

d H

eA

ltH

So

lu

tIo

nS

-

Tab

le 3

Ad

vant

ages

and

Wea

knes

ses

at E

ach

Leve

l of C

olla

bo

ratio

nIn

tegr

atio

n

CO

OR

DIN

AT

ED

C

O L

OC

AT

ED

IN

TE

GR

AT

ED

LEv

EL

1M

inim

al C

olla

bo

ratio

n

LEv

EL

2b

asic

Co

llab

ora

tion

at a

Dis

tan

ce

LEv

EL

3b

asic

Co

llab

ora

tion

On

site

LEv

EL

4C

lose

Co

llab

ora

tion

On

site

wit

h S

om

e S

yste

m In

teg

ratio

n

LEv

EL

5C

lose

Co

llab

ora

tion

Ap

pro

achi

ng

an In

teg

rate

d P

ract

ice

LEv

EL

6Fu

ll C

olla

bo

ratio

n in

a Tr

ansf

orm

ed M

erg

ed

Inte

gra

ted

Pra

ctic

e

Ad

van

tag

es

8 E

ach

prac

tice

can

mak

e tim

ely

and

auto

nom

ous

deci

sion

s ab

out c

are

8Re

adily

und

erst

ood

asa

prac

tice

mod

el b

y pa

tient

s an

d pr

ovid

ers

8 M

aint

ains

eac

h pr

actic

ersquos

basi

c op

erat

ing

stru

ctur

eso

cha

nge

is n

ot a

di

srup

tive

fact

or

8 P

rovi

des

som

e co

ordi

natio

n an

din

form

atio

n-sh

arin

g th

at

is h

elpf

ul to

bot

h pa

tient

san

d pr

ovid

ers

8 C

oloc

atio

n al

lows

for

mor

e di

rect

inte

ract

ion

and

com

mun

icat

ion

amon

g pr

ofes

sion

als

toim

pact

pat

ient

car

e

8 R

efer

rals

mor

e su

cces

sful

du

e to

pro

ximity

8 O

ppor

tuni

ty to

dev

elop

cl

oser

pro

fess

iona

l rel

ashytio

nshi

ps

8 R

emov

al o

f som

e sy

stem

ba

rrier

s li

ke s

epar

ate

reco

rds

allo

ws c

lose

r co

llabo

ratio

n to

occ

ur

8 B

oth

beha

vior

al h

ealth

an

d m

edic

al p

rovi

ders

ca

n be

com

e m

ore

well-

info

rmed

abo

ut w

hat e

ach

can

prov

ide

8 P

atie

nts

are

view

ed a

s sh

ared

whi

ch fa

cilit

ates

m

ore

com

plet

e tre

atm

ent

plan

s

8 H

igh

leve

l of c

olla

bora

tion

lead

s to

mor

e re

spon

sive

pa

tient

car

e in

crea

sing

en

gage

men

t and

ad

here

nce

to tr

eatm

ent

plan

s

8 P

rovi

der fl

exib

ility

in

crea

ses

as s

yste

mis

sues

and

bar

riers

are

re

solve

d

8 B

oth

prov

ider

and

pat

ient

sa

tisfa

ctio

n m

ay in

crea

se

8 O

ppor

tuni

ty to

trul

y tre

at

whol

e pe

rson

8Al

l or a

lmos

t all

syst

emba

rrier

s re

solve

d a

llowi

ng

prov

ider

s to

pra

ctic

e as

hi

gh fu

nctio

ning

team

8Al

l pat

ient

nee

dsad

dres

sed

as th

ey o

ccur

8 S

hare

d kn

owle

dge

base

of

pro

vide

rs in

crea

ses

and

allo

ws e

ach

prof

essi

onal

to

resp

ond

mor

e br

oadl

yan

d ad

equa

tely

to a

ny

issu

e

Wea

knes

ses

8 S

ervi

ces

may

ove

rlap

be

dupl

icat

ed o

r eve

n wo

rk

agai

nst e

ach

othe

r

8 Im

porta

nt a

spec

ts o

f car

e m

ay n

ot b

e ad

dres

sed

or ta

ke a

long

tim

e to

be

diag

nose

d

8 S

harin

g of

info

rmat

ion

may

not

be

syst

emat

ic

enou

gh to

effe

ct o

vera

ll pa

tient

car

e

8 N

o gu

aran

tee

that

info

rshym

atio

n wi

ll ch

ange

pla

n or

st

rate

gy o

f eac

h pr

ovid

er

8 R

efer

rals

may

fail

due

to

barri

ers

lead

ing

to p

atie

nt

and

prov

ider

frus

tratio

n

8 P

roxim

ity m

ay n

ot le

ad to

gr

eate

r col

labo

ratio

nlim

iting

val

ue

8 E

ffort

is re

quire

d to

de

velo

p re

latio

nshi

ps

8 L

imite

d fle

xibili

ty if

tra

ditio

nal r

oles

are

mai

ntai

ned

8 S

yste

m is

sues

may

lim

it co

llabo

ratio

n

8 P

oten

tial f

or te

nsio

n an

d co

nflic

ting

agen

das

amon

g pr

ovid

ers

as p

ract

ice

boun

darie

s lo

osen

8 P

ract

ice

chan

ges

may

cr

eate

lack

of fi

t for

som

ees

tabl

ishe

d pr

ovid

ers

8Ti

me

is n

eede

d to

co

llabo

rate

at t

his

high

leve

l and

may

affe

ct

prac

tice

prod

uctiv

ity o

rca

denc

e of

car

e

8 S

usta

inab

ility

issu

es m

ay

stre

ss th

e pr

actic

e

8 F

ew m

odel

s at

this

leve

l wi

th e

noug

h ex

perie

nce

tosu

ppor

t val

ue

8Ou

tcom

e ex

pect

atio

ns n

otye

t est

ablis

hed

13

a standard framework for levels of integrated healthcare

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