Clinical care is changing across all service environments with an emphasis on improved and collaborative care that reduces cost and risk. It is no longer enough to demonstrate engagement as a treatment strength. Qualifying treatment and outcome success means: understanding population risk, identifying multiple impacts to costs of care, addressing barriers to care and service, implementing culturally congruent and applicable evidenced based practices and interventions, making use of supportive technologies tools to improve communication and treatment adherence, and developing intelligent analytics from big data to improve predictive modeling and positive patient identification for cost-reduction improvements. SAE’s teams of expert consultants stay on top of policy and practice changes to bring innovation changes and knowledge to your team.

Primary Care Integration

The national push to address reduced cost with improved models for integrated care must take into account a paradigm shift from acute care to a true integrated chronic care model. This requires different measures other than preventable admissions of acute care. Otherwise the focus continues to be acute care, not integrated care. For example, pay-for-performance measures continue to focus on acute care need and primary health care intervention. Yet there are recognized behavioral health measures for initial screenings and assessments, medication adherence and support interventions, all of which can be facilitated without a designated behavioral health professional. Value based payment structures exist that recognize “cross stream” providers that collaborate and support preventive interventions and chronic disease management to achieve the Triple Aim of lower cost, quality treatment experience and improved population health outcomes.

In this new paradigm, behavioral health is not an intervention for just “wellness management” but of active treatment and engagement for continuous care to prevent disease escalation and bolstered by supports for emotional health. Integrated care without an emphasis on disease management, and patient involvement only equips those tasked for change with an inadequate toolset.

A system change for integrated care must be inclusive of true integrated care strategies and indicators, include providers across the disciplines, and bring intelligent data applications with robust data platforms that support preventive interventions, patient empowerment and effective chronic disease management strategies.

Be a champion of integrated care and push the discussion from avoidable admission of acute care to integrated care planning with emotional and social health interventions. It is critical for engagement and treatment success for population health — one complex care patient at a time. Contact us to explore how we can help you in this arena.