Integration at Cherokee Health Systems

According to Dr. Parinda Khatri, Director of Integrated Care at Cherokee Health Systems, Cherokee has an embedded behavioral health team in the primary care practice. The behavioral health team provides consultation, assessment, and intervention to address a number of issues ranging from traditional mental health (e.g., depression, anxiety, and diagnostic clarification) to health psychology issues (e.g., self-management of diabetes, asthma, healthy diet, smoking cessation programs for teenagers). In addition to the behavioral health team, a specialty mental health clinic is available. The specialty mental health clinic provides psychiatric consults, case management, therapy, and followups as needed using face-to-face patient care as well as telemedicine.

One unique aspect of the Cherokee model is that the specialty mental health and the primary care behavioral health team work closely together to coordinate care. This approach allows them to refer patients back and forth between specialty mental health and primary care behavioral health depending on the patient’s needs.

However, Dr. Khatri points out that this system took years to create, and barriers still remain. She outlined three obstacles often preventing others from integrating behavioral health into their clinical programs:

1. Financing system: The current financing system is fragmented and archaic. The fee-for-service environment promotes disintegration and inhibits collaboration among providers.
2. Workforce: The workforce is not prepared for integration. There is a lack of providers with the training needed to function in primary care settings since providers are typically trained in silos rather than team-based approaches.
3. Operational: Currently, there are different ideas of what integration is and what the model is, which creates confusion and interferes with the integration process since people are working on different goals and ideas of what integration should be.

Despite these barriers, Dr. Khatri is optimistic about the future: “The coming years are going to be very exciting. The field will be moving to the next step, which includes (but is not limited to) building and better defining the model of mental health and primary care integration. In the following years, we will have the findings from the ongoing research carried out by pioneers in the field, which will allow for identifying which components are effective, as well as making more evidence-based interventions available for primary care settings.”

For more information:

Hunter CL, Goodie JL. Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home. Fam Syst Health 2010;28(4);308-21.