Will peer supporters become Health Home integrators?

Violent vivid lightening, punctuated by pervasive piercing thunderclaps and monotonous moving rain, has been a hallmark of Summer 2014. Similarly, this summer has witnessed the “sturm und drang” of a tectonic cultural shift fostered by the Affordable Care Act (ACA) to develop integrated primary care medical homes and integrated behavioral health homes. Some very promising efforts focused on collective wellbeing even extend these endeavors to encompass neighborhoods or communities. The purpose is to make available a “one stop shop” for illness care, to facilitate disease prevention and health promotion, and to reduce cost—the “Triple Aim” so well articulated by Don Berwick, the brilliant health policy observer.

Unfortunately, this enthusiasm only infrequently extends to a careful analysis of the human resources required to staff these new medical and health homes. Clearly, these emergent homes will require fully integrated care teams that include primary care physicians, behavioral health specialists, peer supporters, and potentially other specialists as well, depending upon the nature of the population covered by the home. For example, an elderly population will require a different team configuration than a working-age population.

Several months ago, I described a new role for peers in medical and health homes—an Integrated Peer Supporter (See here). This new role will involve support, mutuality, and recovery assistance not only for those with behavioral health conditions, but also for other clients with physical illnesses or chronic diseases. The Integrated Peer Supporter must be a full member of the integrated care team.

Here, I would like to introduce another essential role for medical and health homes. This role—the Health Home Integrator—will provide essential support to the integrated care team and to the client. Persons who engage in this role will have two primary functions: organizational coordination among health home components and personal coordination for each client.

Organizational Coordination: Most medical and health homes will not be unitary entities. Rather, they will be umbrella organizations that bring together pre-existing health care providers. For example, the home may join together a primary care practice with a community mental health center. More complex homes likely will have more than two constituent organizations.

To get the integrated care team to function well, professionals and peer supporters will need to be coordinated for each health home client. Logistically, this means coordination of schedules, other resources like space or transportation, and even fostering or sustaining needed links with outside organizations. Success with each care engagement is likely to depend upon how well all of these features are brought together. In a word, Organizational Coordination will determine how well the services of the home will be brought to the client.

Personal Coordination: This function is the complement to Organizational Coordination. In a similar manner to organizational preparation, the client needs to approach care fully prepared for success. This only will occur if key information and key supports are available for the client.

Information will be needed on personal supports outside the medical or health home, on outside social wrap-around services, on prior care, including medications, on current health insurance coverage, on availability of electronic medical and personal health records, and on a myriad of other personal factors that will spell success or failure for the care. In a word, Personal Coordination determines how well prepared the client comes to the care of the medical or health home.

To be most effective,  Organizational Coordination and Personal Coordination for each client will need to be undertaken together by the same person—the Health Home Integrator.  

Clearly, peers supporters not only are ideally prepared to become Integrated Peer Supporters, as described earlier, but they also are very well suited to take on the broader role of Health Home Integrators.  Through a combination of formal and on-the-job training in organizational structure, health program operations, and team formation and operations, peer supporters can quickly become very adept Health Home Integrators.

Dialogues can be undertaken between local colleges and emergent medical and health homes regarding training needs for Health Home Integrators. Further, small demonstrations can be developed to “prove” this concept in actual practice, including appropriate reimbursement mechanisms. This very important developmental work will need leadership from the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration, the two federal agencies charged with leading the implementation of medical and health homes.

If we are to develop medical and health homes that are person-centric, health- and recovery-oriented, and trauma-informed, then the peer and consumer communities, the behavioral health communities, and the primary care communities will need to work closely together to create new possibilities for the future, including the Health Home Integrator. How very energizing to contemplate this opportunity!