Integrated Family Care Improves Outcomes, Generates ROI

The new care model recognizes that family dynamics impact health and cost of care.

Healthcare providers and payers should adopt integrated family care to boost clinical outcomes and generate return on investment, a United Hospital Fund report released this week says.

Families can have a major impact on an individual's good health, including caregivers easing stress on family members who face serious illness and caregivers supporting the physical and mental health of children. Families can also contribute to an individual's poor health such as dietary habits that lead to obesity.

"Focusing on these dynamics yields an opportunity to invest in supporting families as an effective means for improving population health," the UHF report says.

There also is a strong business case for having a family focus in healthcare delivery and reimbursement. The report cites research published in 2007 by the National Business Group on Health that found four advantages for companies that use insurance benefit design and other tools to foster good maternal-child health: lower healthcare costs, increased worker productivity, employee retention, and a more fit workforce over the long term.

In addition, other research on child-parent psychotherapy estimated the return on investment at $15 for every $1 invested.

Integrated family care has several primary elements, the UHF report says.

• Similar to behavioral health integration into primary care, integrated family care ensures all family members' healthcare is effectively coordinated
   
• Healthcare delivery and payment models are crafted to promote family-based approaches to care that decrease care silos between family members
   
• The approach integrates physical and mental health care as well as social services

There are three pillars in the framework for establishing integrated family care, the report says.

1. Insurance is foundational
 

Health insurance for both children and their parents is crucial for effective integrated family care, the report says.

"Insured children with uninsured parents are more likely to experience insurance coverage gaps, not have a usual source of care, have unmet health care needs, and miss preventive care services. Uninsured parents are also less likely to receive care for their own medical conditions, such as mental health disorders, that when left untreated can adversely affect their child's health."

2. Family-centered care approach
 

Integrated family care shares principles with the patient centered medical home model of care, the report says.

"The model stresses partnership with families and a continual effort to be responsive to their needs. The primary care team is expected to encourage and support the patient and his or her family in making decisions about treatment and in developing and implementing the plan of care. The PCMH practice also takes on a major responsibility for coordinating care with other providers on behalf of its patients."

3. Building bridges
 

Practitioners of integrated family care identify health conditions of family members that affect a patient's health and they strengthen family bonds, the report says.

"The best-known example of 'bridging efforts' may be the implementation of maternal depression screening during well-child visits and the billing for such services under the child’s insurance plan. Other clinical interventions akin to this include detection of parental substance use disorder or significant parental stress."

Integrated family care openings
 

There are several opportunities to pursue the integrated family care model, the report says.

• Providers and payers can increase awareness of evidence-based family interventions such as the Blueprints for Healthy Youth Development database and seek "braided funding" such as block grants from the federal Substance Abuse and Mental Health Services Administration.
   
• Providers and payers should promote maternal depression screening in children's primary care.
   
• Collecting and examining state data on complex families can identify risk factors facing children.
   
• Payers should offer planning grants to providers that want to develop integrated family care through new partnerships such as behavioral health providers in New York that received grants to increase readiness for value-based payment.
   
• Payers and providers can use the Center for Medicare & Medicaid Innovation's Integrated Care for Kids and Maternal Opioid Misuse demonstration projects to test integrated family care models.
   
• Health plans can work with providers to test new payment models that encourage collaboration between providers that care for different members of the same family.