Tailoring collaborative care to fit the need: Two contrasting case studies

Abstract

As experience in full-fledged collaborative or integrated behavioral/primary care repeatedly teaches us, one size does not fit all. Practice patterns need to be realigned, budget issues must be resolved, and myriads of not-so-obvious impediments stemming from turf interests must be effectively addressed. Healthcare delivered for decades in a traditional manner has created a number of fiefdoms and silos, each headed by a cadre of chiefs, seniors, and adherents has resulted in an array of jurisdictional land mines, and stepping on one may wreck an otherwise well-intentioned collaborative program. Healthcare often takes place in bureaucracy and we know that bureaucrats are interested in maintaining or increasing their power and budgets. Integrated care can seem to threaten some of these individuals, particularly those in behavioral health specialty care (but sometimes in psychiatry too) as the transformations integrated care involves can seem threatening to those vested in the status quo. However, a deeper analysis would generally show that primary care and behavioral health professionals will be the winners in integrated care, while certain medical specialty care (e.g., emergency room, ER, cardiology) may be the financial losers as patients' behavioral and medical problems are resolved in the integrated care setting. However, the real winners are the patients, who receive more efficient and effective care; and the payers (including the American taxpayer, who pays for over 50% of all medical care), who gain financial efficiencies through medical cost savings. © 2008 Springer New York.