Objectives: The objective of this study was to describe levels of integration of primary care, oral health, and mental/behavioral health services in several Federally Qualified Health Centers (FQHCs) and to examine commonalities and differences in systems and processes that enabled service integration.
Methods: Project staff conducted case studies in 6 FQHCs providing integrated health services to mixed patient populations in Colorado, Missouri, New Mexico, New York, Ohio, and Washington, DC. Site visits included interviews with multiple stakeholders using a protocol of questions to guide informants to the main topics of interest.
Results: The case study organizations placed at Level 5 or Level 6 on a hypothetical standard framework for integration designed by the SAMHSA-HRSA Center for Integrated Health Solutions. Each demonstrated close/full collaboration using a transformed integrated practice model. Organizations characteristically used integrated electronic health records (functional integration); included integration as a primary organizational goal (normative integration); had leadership that encouraged engagement and innovation (organizational integration); implemented hiring practices to assure that employees identified with the organizational mission (system integration); encouraged formal and informal communication across disciplines (professional integration); used team based care delivery models (clinical integration); and engaged with the larger community to improve their collective impacts on patients (vertical integration).
Conclusions: The need for integrating service delivery was obvious in these health centers because of their complex patient populations with multiple medical comorbidities and other unmet needs. Integrating service delivery was the reasonable path to assure that providers helped patients to improve health status and life outcomes.