In January 2016, CIBHS is convening the Care Coordination Learning Collaborative (CCLC), a Breakthrough Series Learning Collaborative aimed at improving the overall health of individuals who have serious mental health disorders through care coordination among primary care and specialty providers.
Over a period of 15 months, behavioral health providers will design new service delivery systems and redesign existing systems to provide coordinated behavioral, medical, and social services to improve the health status of individuals who have complex, co-occurring conditions. Agencies will build a seamless experience of care that is person-centered, cost effective, and results in reduced health disparities and improved health and wellness.
CCLC, CIBHS’s fourth care integration/coordination focused collaborative, will bring together behavioral health providers to develop processes to coordinate care across providers and provide services from a whole health perspective. Agencies will build their internal infrastructure to enable coordination with other providers while also developing linkages with partners to deliver an integrated experience of care. CCLC participants will test and implement changes to:
Gather and share information about shared patients/clients
Team up on care, including conducting regular multi‐ disciplinary team meetings and consultation among individual providers
Develop and use shared problem lists or care plans
Reconcile medication and other interventions
Support patient self‐management and healthy lifestyles
Improve access to care for people with unmet needs and populations experiencing health disparities.