In the January 26 issue of this newsletter, we provided an overview of integrated care and identified barriers to its implementation.  This issue addresses four additional barriers to the implementation of integrated care:

  • Care provided in silos
  • Need for supportive regulations, insurance reform, and coverage expansion
  • Need for adequate infrastructure
  • Access particularly in rural areas

Nearly 50% of all adults have at least one chronic illness, and more than 75% of health care costs are due to chronic conditions such as hypertension, asthma, diabetes, and heart disease.  Having several chronic conditions can cost as much as seven times more than treating patients with only one chronic illness. The prevalence of these chronic diseases is higher for individuals with mental illness when compared to the general population. It is estimated that 68% of adults with mental illness have one or more chronic physical conditions and that 29% of adults with medical conditions have mental disorders.  People with serious mental illnesses are more likely to have multiple physical disorders and to die 25 years earlier than the rest of the population. More than 20% of adults with mental illness have a co-occurring substance use disorder.  Management of these co-occurring conditions becomes more complex, in terms of prioritizing treatment, coordinating care, and polypharmacy. Integrated care has been advanced as a way to manage the health care of these individuals as challenges remain in primary care or behavioral health settings.

Supportive regulations, insurance reform, and coverage expansion are needed in order for integrated care to be fully implemented. Practitioners have identified financial challenges introduced by segregated physical and mental health reimbursement practices as one of the key barriers to integrated care. Corresponding to this barrier is the need for infrastructure that promotes:

  • care coordination
  • communication across departments and administrative level
  • the incorporation of social and other support services
  • an integrated data management system and quality improvement process
  • accountability
  • consistent authorizations
  • a culturally sensitive workforce

Access, particularly in rural areas, may be a barrier to integrated care especially in light of the following challenges:

  • lack of public transportation
  • limited office hours
  • paucity of healthcare professionals (e.g., primary care physicians, psychiatrists)
  • long wait lists
  • lack of proximity of services