On day two of our Implementation Summit in June, I referenced a Radiolab podcast episode I heard in the beginning days of physical distancing that continues to stick with me. The reporter had come across a list of items that Cold War era planners would preserve in the event of a nuclear event- items that could be used to rally and bring us back together as a country. The reporter then took this idea to current thinkers, asking historians and others what items they might preserve today.  My favorite answer came from Arlo Iron Cloud of the Lakota Nation, the Communications Manager and sometime radio host of KILI radio community radio station serving the Pine Ridge Reservation in South Dakota.  Arlo tossed around a few thoughts, but ultimately decided he would likely save nothing, not even treasures passed down for over 800 years within his family and community. He said his community traditionally does not write stories down, and believes this is a good thing: “The United States of America, the people that belong to it, sometimes I think they take the things that were written by your forefathers too literally. And they can’t adapt it to the future.”

I’ve been thinking about this in terms of our current healthcare system and specifically our behavioral health integration work: the idea that we are limited by what has been done in the past. We know, today in 2020 more than ever, that health equity and social determinants of health must be part of our health care delivery reform conversations. We’ve known for decades that a person’s environment and behavioral health affects physical health, creating unnecessary burden and cost to healthcare systems. Yet we still hear it’s too hard to regularly screen patients, or coordinate effectively between physical and behavioral health provider teams. 

We have already seen some innovative telehealth work in response to COVID-19. Locally, we have started re-investing in communities to prepare for the current and future increased need of mental health services. Let’s continue this expanded way of thinking.  What would it look like if the PHQ-2 or PHQ-9 was a seventh vital sign as part of routine care? How would the patient benefit from changes to primary care reimbursement for SBIRT or SDoH screening, ensuring every appointment had sufficient time for these patient-centered interactions?  What if we re imagined the patient care team to center the role of community health workers, who often have the most trusted relationships with our vulnerable patients?

We are a community that touts itself as continuously working toward a patient-centered model.  If we truly want to be patient-centered, let’s actually put the patient at the center of our model. For every dollar spent on healthcare, how much goes toward the patient interaction verses say, the electronic health record system or administrative burden? We have let legacy systems dictate how we deliver care, rather than the actual needs of our patients. 

We must permanently delete the brick wall statement of ‘well, that is just how it has always been done’ from our vocabularies. This way of thinking is no longer acceptable.  Think back to the calls for a Marshall Plan for primary care which came out at the beginning of this pandemic – it’s now time for a Marshall Plan for integration. Let’s take this momentum of change we all feel in the air of 2020, and categorically apply it to bi-directional care. 

Join us to help turn these thoughts into action in our virtual office hours starting September 15 from 3:00 – 4:00 pm.  Using the Action Plans we completed together on day two of our Summit, we will talk through existing barriers to integration that your organizations face, and share ideas on how to overcome them. Join us via Zoom here.

By Amy Etzel, Implementation Manager, Bree Collaborative