5 minute read

On July 13, 2023, Health Federation of Philadelphia (HFP) announced a new investment in integrated care by the Philadelphia Department of Behavioral Health and Intellectual Disability Services (DBHIDS), which will allow HFP to hire a Director of Behavioral Health Integration position.

The new Director will be responsible for leading all training and consultation activities to support integration of behavioral health in primary care across provider organizations that comprise the Philadelphia Integrated Care Network (PICN). Through the PICN, HFP provides ongoing support to 18 healthcare organizations operating more than 70 clinical sites or practices throughout the region.

It is not unique for county governments in the United States to operate or support primary care systems. Los Angeles County Department of Health Services operates over 100 primary care clinics throughout Los Angeles County, providing care to over 2 million patients each year.

Cook County Health and Hospitals System operates 12 primary care clinics in Cook County, Illinois, providing care to over 1 million patients each year. These clinics provide essential health care services to millions of people, and they play a vital role in ensuring access to quality health care for all.

But it is unique for county departments to support integrated care learning communities. HFP has occupied that rarefied space for a long time. Now, they are entering new territory by seeking a clinician-leader and expert in integrated care to strengthen and expand the PICN.

I contacted Natalie Levkovich, the CEO of HFP, for more background on this important development. Our conversation is summarized below.

MM: This new director position is possible because of support from the Philadelphia Department of Behavioral Health and Intellectual Disability Services (DBHIDS) budget. How did this support develop? What do you believe were the deciding factors that helped DBHIDS feel confident in funding this position?

NL: In 2005, I started to work on making behavioral healthcare provided by Federally Qualified Health Centers (FQHC) operationally and financially sustainable. We did it incrementally and in concert with the behavioral health managed care organization, a branch of the Philadelphia Department of Behavioral Health and Intellectual Disability Services (DBHIDS).

So, our collaboration with the Department goes back 18 years now. The truth is that you cannot just drop a behavioral health consultant (BHC) into a primary care clinic. So, HFP took on the work of training and consulting with the provider organizations to integrate the BHCs; and we did it in a collective, cost-effective manner. The spread was relatively rapid. In the face of that support, additional FQHCs were able to adopt and modify their practice without reinventing the wheel each time.

We realized that the support to the provider organizations should be ongoing, so we included monthly continuing education, professional development, site-specific technical assistance, an annual boot camp for Primary Care Behavioral Health (PCBH) fundamentals, fidelity monitoring, and peer support. All combined, we established a community of practice.

Over a year ago, I met with DBHIDS to review the value and impact of the HFP’s work and the commitment of DBHIDS to integrated care. We discussed how future sustainability required sustained clinical leadership. After a year of dialogue, the funding necessary to create the new Director position was added to the 2024 budget for DBHIDS.

The deciding factors were a long-term partnership, demonstrated value, and persistence, persistence, persistence. The spread of integrated care throughout PICN was stable because of ongoing HFP activities and consistency with and fidelity to integrated care practice principles. DBHIDS saw the return on their investment in HFP and felt confident in moving forward with new funding.

MM: The new director will be responsible for planning and implementing training and consultation activities to support 18 healthcare organizations operating more than 70 clinical sites or practices. What do you believe will help the director be most successful in working across such a large regional network?

NL: First is confidence from the providers. We have long-standing partnerships with the PICN provider organizations and their voluntary participation in this community of practice. The providers believe in what we are doing and have first-hand experience of the value. So, if we make a smart hire with this Director position, then we can sustain that confidence.

Second, the new Director will need time to engage the clinical partnerships and develop relationships. I will remain as involved as needed.

Finally, we need to go to the next level by bringing in new intervention models that are compatible with PCBH and increase evaluation and measurement. Perhaps we can blend PCBH and CCM (Collaborative Care Model) and introduce trauma treatment. We expect the new Director will bring something new to the table. and have the opportunity to innovate.

MM: Other state, county, or city governments may look to HFP and DBHIDS as a template for supporting and expanding integrated care. What recommendations or lessons learned would you offer?

NL: This is not an investment in direct integrated behavioral healthcare. This is an investment in support for integration. That is an important distinction. There is no one-size-fits-all solution. Each state and county has different circumstances and variables.

The basic ingredients, though, are relationship-building, presenting the work in a way that speaks to the goals and interests of the governing entity, being patient, even across many years, and articulating value over and over. How that spins out will be unique to that jurisdiction and should speak to the strategic interest of integrated care. We have learned that it is essential to demonstrate value to the providers, as well as to government stakeholders, and then help the government entity listen to their provider community.