Supporting Integrated Health Care through Practice Coaches

Background and Purpose: Whether successful health system redesign occurs under the Affordable Care Act remains to be seen, yet challenges to integrating primary care and mental health services have already been noted. A descriptive analysis of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Primary and Behavioral Health Care Integration grants program indicated that several challenges exist across various approaches to integrating care, including difficulty recruiting and retaining qualified staff members; issues related to data collection and use of electronic health records; licensing and approvals; and limited physical space (Scharf et al. 2013). This study examines the use of “practice coaches” that were funded by a private health plan as a means to transform a county health system to provide integrated primary and behavioral health care.

Methods: Key stakeholder interviews were conducted with 5 health plan executives and 6 practice coaches who were working with 14 clinical practices to support integrated care. These in-depth interviews focused on the rationale for embedding outside practice coaches within clinical settings, the background needed to be an effective coach, and the process of providing coaching on integrated care both in terms of barriers and facilitators. Thematic analysis of transcribed interviews was conducted and the credibility of the findings was supported by several strategies of rigor including prolonged engagement (researcher was embedded within the integrated care initiative), member checking, and independent co-coding of transcripts.

Results: Coaches were regarded as essential for sustaining system change and critical in providing new information to clinics who were struggling to change operations to better manage population health. Coaches had various backgrounds including social work, public health, and medicine but had years of both practice and administrative experience. Recruiting some coaches who were medical doctors (MDs) was decided upon because practicing MDs were not responsive to coaches from other disciplines. All coaches agreed that teaching and practicing motivational interviewing was important to change practice.

Conclusion and Implications: Strategies to address the challenges involved in integrating primary and behavioral healthcare are needed. This study found practice coaches to be a viable strategy to support integrated care but careful planning and selection of coaches is needed for programs to be responsive.