Three years ago the Collaborative Family Healthcare Association (CFHA) set out to report on the spread of integrated care across the United States primary care system. Our initial report on findings in 2020 elicited interesting findings on the breadth and types of care being provided. Here we provided updated data which appears to demonstrate greater uptake of all kinds of integrated care approaches.
For the novices out there, integrated care, or the coordination of multiple health professionals to work together in providing patient-centered whole-person care, is becoming increasingly popular as a way to improve outcomes and reduce costs associated with healthcare. With this popularity comes an influx of different models for integrated care that each clinic must consider when deciding what kind of services they will offer their patients.
To gain insight into which kinds of integrated care models are being used across primary care sites in the United States today, an open survey was conducted with 182 participating organizations located across 45 states and territories, serving between 3.7 million to 8 million patients each year (across 1,088 sites). For comparison see the 2020 post. This data is inclusive of the prior data since we are aggregating data on the integrated map survey. It is also important to understand that the data is self-report and the sites are self-selected (they choose whether to participate or not). As such we are not claiming to have surveyed the entirety of primary care clinics in the United States and its territories, nor that we have a representative sample size. A particular limitation of the data is that we are essentially surveying clinics that have some form of integrated care happening and as such do not have a picture of clinics not employing integrated care.
Half (50%) of these clinics identified themselves as Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Safety Net providers such as free clinics, community health centers and academic medical centers. Of note, since the original data was published CFHA added a listing for centers offering training in integrated care and 15 of the sites self-identified as offering training from the Master’s to post-doctoral training levels.
|Service Type||2020 (N= 80)||2023 (N= 182)|
|Medical Family Therapy||21.3%||39.5%|
So, what do we make of this? For one, it appears that healthcare provider organizations are employing a myriad of strategies to provide team-based care. While PCBH is the most prevalent model in use in this sample, the overlap with other models and approaches is beyond happenstance. There are a number of issues that providers face on the ground in providing care to patients and they are voting for a number of different solutions to those issues ranging from traditional behavioral health service delivery to more targeted approaches such as various forms of psychiatry support. Notably the pre-pandemic rate of telehealth jumped significantly in the 2023 sample for obvious reasons.
The other big take-away from this data set is simply that no solutions appear to be on the wane. In other words, in the real-world marketplace of ideas/ models, each of the approaches listed as approaches to providing behavioral health services in a primary care setting, increased in their utilization. This seems to indicate that these approaches have some staying power and are part of a larger recipe for providing integrated care to populations. One could surmise that clinics are making active decisions related to the needs in their populations, the skills of the available workforce and the costs/benefits of the particular approach type to determine a recipe that fits best with their current circumstances.
The integrated care map survey remains open and we will continue to monitor, update and report on the data in order to create these snapshots of where the trends are for the provision of integrated physical and behavioral healthcare in the primary care sector.
Photo by GeoJango Maps on Unsplash
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