Integrating care for underserved populations: A case study of system change

This case study will fully describe the specific steps undertaken to accomplish effective change in clinical practice and related policies to create conditions for sustainability. This case focuses on the integration of behavioral health services into primary care in multiple provider settings and includes collaboration across disciplines and among providers, the Medicaid reimbursement system and other stakeholders. Each element of the change process, including capacity building, practice redesign, and advocacy, will be described. The role of coordination and leadership will be explained as an integral part of the process and replicable lessons learned will be highlighted. The dramatic impact of this system change on access to behavioral health care, on quality of care overall and on the financial viability of the service will be detailed. Elements of the clinical model, its relevance to achieving public health goals, its evolution and expansion, and its impact on service utilization and on revenue in the community health center environment in Southeastern Pennsylvania will be presented.