A Framework for Measuring Integration of Behavioral Health and Primary Care

The Integration Framework has two major components, which further specify the components of integrated behavioral health care. These components are functional domains and measurement constructs. The functional domains and measurement constructs are adapted from previous work on the Lexicon.^{[1] [2]}

• Functional Domains divide and organize the Integration Framework into high-level functions or actions. There are 11 functional domains that are organized as follows:
• Domains #1–4 describe the clinical functions necessary for integrated behavioral health care.
• Domains #5–9 describe the enabling functions that support integrated care and allow it to operate successfully on a meaningful scale. These enabling functions are important because integration of behavioral health is not only a matter of clinical processes, but of organizational functions that enable the clinical functions to happen consistently, reliably, and for the entire target population.
• Finally, the potential outcomes of integrated care are described in Domains #10–11. During this first phase of IBHC Measures Atlas development, the scope of outcomes measures was limited to patient experience. Additional outcomes domains, such as provider experience, system experience, clinical outcomes, and financial outcomes, may be considered for inclusion in subsequent releases of the IBHC Measures Atlas.
• Measurement Constructs describe specific characteristics (i.e., structures), actions (i.e., processes), and outcomes that can be observed during integrated behavioral health care. Structure and process constructs can be used to understand if a team is working collaboratively and integration is actually taking place. Often, structures and processes appear in a pattern. Within a functional domain there may be a structural construct, such as a plan describing how an organization will perform a certain aspect of integrated care, and then, there is a process construct to ensure the plan is consistently implemented. Domain #3, Patient Identification, is an example of this pattern. The structure construct states that methods to identify and prioritize individuals for integrated care should be specified in an agreed-upon workflow, and the process construct states that those agreed-upon methods should be used consistently. Outcomes constructs describe the potential results of implementing the structures and processes of integrated behavioral health care.

This framework is presented below. It begins with the overarching definition of integrated behavioral health care. Then, each functional domain and the related measurement constructs are mapped together flowing from left to right. Experienced evaluators may wish to review the attached table displaying both the Integration Framework and the core measures (PDF 0.28 MB) associated with each functional domain.

Readers may note that certain principles in the Integration Framework are applicable to health care in general, as well as to integrated behavioral health care specifically. For example, the functional domain of “Care Team Expertise” may be applicable to care teams for a variety of conditions. For this IBHC Measures Atlas, the focus is on care teams for integrated behavioral health care; therefore, concepts like behavioral health expertise, professionals, patient populations, or specific patient needs are highlighted in the measurement constructs for that functional domain.

Interpreting concepts of “good health care” through the lens of integrated behavioral health care provides two advantages. First, it places integrated behavioral health care in the context of good care, in general, and reinforces the fact that integrated behavioral care is a part of broader high-quality health care system. Second, it increases the number and variety of measures available to implementers seeking to assess their integrated behavioral health care programs. Measures and concepts originally pertaining to good health care are included throughout the next section, Overview of Measures. Included in the IBHC Measures Atlas.