Health Home Overview
Research shows that people with serious mental illnesses and substance use disorders die younger than the general population, often from high-risk behaviors (e.g., smoking) and treatable conditions (e.g., cardiovascular disease and cancer.) These findings have led the behavioral health field to seek ways to improve access to preventive services, wellness programs and medical care. The mental health and substance use treatment communities have been working on developing interventions that may reduce and, hopefully, eliminate this type of early mortality. An important component of this work has focused on how to improve access to primary care, either by strengthening linkages to community-based primary care providers or by bringing primary care providers in-house.
Primary care tends to be organized to provide acute care, but there are many conditions, such as asthma and depression, that require a system of ongoing treatment and support. Creating a model of care that attends to a group of patients who present with the same disease or illness will lead to better outcomes because they all share similar healthcare needs. When you can engage all members of the target group in treatment and monitoring, rather than just responding to whomever happen to show up in the provider’s office, healthcare becomes more effective because it’s easier to keep track of everyone who needs it.
Shifting from an acute care model to a continuing care model requires the entire primary care practice to change. Recently, the chronic care model has been reexamining how services — including preventive and primary care — should be delivered for all health issues. Numerous studies have shown the chronic care model’s value in improving the delivery of behavioral healthcare in primary care settings, as well as the delivery of primary care services in mental health and substance use treatment settings.
At the base of the chronic care model are productive interactions between an informed, activated patient and the prepared, proactive practice team. When a medical team helps a patient understand the circumstances surrounding his/her medical situation, the patient is then empowered to be a full partner in his/her care. Multidisciplinary staff members work as a team with clear roles and a shared plan, arriving at each patient contact with goals and a plan rather than simply responding to whatever issues happen to come up during an appointment or consultation.
This self-management model can have a dramatic effect on out-of-office disease treatment. When patients present with conditions like asthma, diabetes, heart disease and obesity, they spend the majority of their time dealing with the effects everywhere but the doctor’s office. They are on their own, making decisions about diet, exercise and medication adherence. As such, it is vital that patients feel confident and educated enough about their conditions to absorb the accompanying daily responsibilities.
The success of the chronic care model will rely on more than changing how doctors interact with their patients. Care management functions can and should also be assigned to different types of providers. Social workers are highly skilled at coordination activities, whereas nurses have more background in medical management and education. Trained peers, community health workers and health navigators are also effective collaborators, given how they draw from personal experience in order to connect with patients. Community health workers have effectively provided screening, monitoring, patient education and self-management support in multiple studies focused on chronic health conditions like diabetes and asthma. Peer support programs have capitalized on the lived experience of individuals with mental health and substance use disorders to offer education and self-management support services to patients, often with positive outcomes.