Challenges in implementing models of coordinated care

Summary: The purpose of this study is to explore implementation challenges behavioral health agencies have faced in moving toward new models of care coordination which have been mandated by health care policy. Specifically, this study looks at six behavioral health agencies in a rural region of a southwestern state. Three agencies had adopted a colocated model of care coordination which involved partnering with a local Federally Qualified Health Center to provide primary care services at the behavioral health agency facilities. Three other agencies included in the study had adopted a fully integrated model of care coordination which involved hiring their own practitioners to provide primary care services at their facilities. Findings: Results from this qualitative study identified seven areas of implementation challenges experienced by agencies including financial mechanisms, regulation, electronic health records, role clarification, information sharing, medical provider stigma, and staff training on coordinated care. Some of the most common challenges for all agencies regardless of the model being implemented were funding mechanisms, information sharing, and regulation. Application: Findings from this study indicate that although health care policy has moved toward a more progressive form of health care, challenges still remain that threaten the sustainability of such care. Improvements at the policy level are needed to reform payment mechanisms and regulatory burden, in addition to making improvements at the local level to train practitioners.