Michigan has been pursuing integration of behavioral and physical health for several decades now, primarily using various changes in Medicaid payment systems as the driver. Even though almost everyone sees integration as a positive improvement, our health care system is so complex that actually producing effective integration remains an outcome for our future. It doesn’t exist except on small scale in a few places now.
In addition, the money involved motivates actors in the larger systems of physical and behavioral health to view integration primarily as a financial support for whatever part of the health system the actors occupy. The essence of capturing all that money is largely seen as a political task, not a health care task.
This struggle between who will control the money and how effective integration actually happens is driving the current fight between Michigan Managed Medicaid health care (the responsibility of various Medicaid Health Plans) and Michigan’s managed behavioral health system (managed by what are called PIHP’s through their relationships with local community mental health agencies).
But, what does integration actually mean? Why does it seem to be so difficult to choose a path of integration?
It is easy enough to say what the outcome of integration should be:
All your behavioral and physical health supports should be coordinated with one another through a person centered plan and everyone who provides services to you should understand all the supports you are getting through that PCP.
Although most of what you hear about integration is about who will control the money, that outcome is supposed to be the end result. But control of the money doesn’t in any way guarantee that your services and supports will be truly coordinated by a person-centered plan. The arguments about who controls the money are really about the “most efficient” and “least costly” way to providing the services and supports.
These terms don’t really mean what you might think. They don’t mean that services and supports will be provided at the highest quality for the lowest cost. They mean that the services and supports will be provided at the lowest cost regardless of the impact on quality.
So, when you hear someone talking about integrated care and how it should be provided, always ask whether that means anything other than the least possible services and supports that the system can provide on the cheap.