Collaboration in Action: Primary care and behavioral health integration in Oklahoma
Virtual Site Visit Summary
In March 2022, the Delta Center for a Thriving Safety Net, in partnership with Oklahoma Primary Care Association (OKPCA) and Oklahoma Behavioral Health Association (OBHA), hosted a virtual site visit for Delta Center grantees. The site visit aimed to showcase collaboration across primary care and behavioral health at state and clinical levels, featuring the OKPCA, OBHA, and patients and providers from federally qualified health centers (FQHCs) and community behavioral health organizations (CBHOs), including Certified Community Behavioral Health Clinics (CCBHCs).
The site visit included an overview of Oklahoma’s state policy landscape, a spotlight on the state associations’ work together, and examples of primary care and behavioral health integration in action. Providers from the featured organizations shared compelling examples of how peers and individuals with lived experience have helped to improve care for clients. In doing so, they are helping shape an overall system rooted in what is best for the individuals served.
“We are working hard to create a potluck meal out of what we can each bring to the table. We all have bits and pieces that when we bring them together, we're able to provide better care to the citizens of our state.” —Sara Barry, CEO, Oklahoma Primary Care Association
A Close Partnership in Oklahoma
The day began with Sara Barry (Chief Executive Officer, OKPCA) and Julia Jernigan-Smith (Executive Director, OBHA) describing the policy context in Oklahoma. They highlighted how OKPCA and OBHA have partnered to drive policy and practice changes in the state and with their member organizations. As Sara Barry emphasized, “Working together is what is in the best interest of the patients and communities we serve.”
Oklahoma is transitioning to Medicaid managed care after passing Medicaid expansion in 2020. While lawsuits have delayed the transition, the associations have worked together closely to prepare for the change. Barry explained, “A lot of our work has been trying to prepare our providers and to align our networks so that as Medicaid managed care does move forward, we’re more integrated.” One important aspect has been shared commitment to building capacity among their members by extending invitations for trainings offered through both associations to the combined member organizations. For example, “We had some joint sessions at our clinical annual conference last year and we received good feedback. Having had the opportunity to do that through the Delta Center initiative has been very good timing for all of the things that we have going on in our state, with respect to not only COVID and JEDI issues, but also to manage the conversion to managed care,” Barry noted.
The associations meet regularly to strategize around ensuring the highest quality care for patients. For example, they held joint discussions with legislative leaders and with the state Medicaid agency around plans for Medicaid managed care. Through the managed care initiatives, they have tried to highlight how social determinants of health affect the communities they serve and have supported policy efforts that may directly benefit the members of one association, but not necessarily the other. For example, the OBHA supports reimbursement for community health centers for care provided by licensed professional counselors under supervision. On the flip side, the OKPCA supports the continuation of CCBHCs, which can facilitate increased capacity in the behavioral health system. This helps CHCs to have a more robust system to which they can refer clients.
“Being co-located has been a real benefit to us, to not only be able to do training initiatives, but also for brainstorming ideas and for camaraderie..” —Julia Jernigan-Smith, Executive Director, Oklahoma Behavioral Health Association
The associations’ geographic proximity has facilitated this close collaboration—the associations co-located in 2021 as part of an intentional strategy to strengthen their partnership and behavioral health integration in Oklahoma. The decision to co-locate was spurred by a recommendation from a Delta Center alumni grantee in Missouri. Co-location has made joint policy initiatives easier, including those around Medicaid managed care, telehealth and vaccines.
- Partnership between the OKPCA and OBHA has resulted in a collective voice and concrete advocacy efforts in Oklahoma.
- Having primary care and behavioral health organizations as part of a single clinically integrated network honors the strengths of both, and sets the stage for collaborative care and value-based payment.
- Strength in numbers is important and especially beneficial in a managed care environment where negotiating on behalf of many lives offers more clout.
- Joint advocacy is not a zero sum game. Policies can benefit either primary care or behavioral health without the other experiencing harm.
- Collaboration requires trust and a shared confidence that each organization will consider how a policy will affect the others and commit to moving in the same direction.
Promising Partnership Practices: Aligning and Integrating Primary Care and Behavioral Health
Next, brief presentations by four organizations showcased primary care and behavioral health collaboration on the ground in Oklahoma communities. The organizations included NorthCare, one of Oklahoma’s largest CCBHCs; Variety Care, OK’s largest FQHC; Center for Therapeutic Interventions (CTI), a comprehensive community addiction recovery center; and Health and Wellness Center, a community health center with eight locations serving the southeastern part of the state.
Each site provided a brief overview of the center’s facilities and patient stories to demonstrate best practices. NorthCare described how their collaboration with Variety Care has enhanced care for patients. Variety Care’s facility tour showed how having adjacent primary care and behavioral health rooms streamlined the process of patients accessing both services. Meanwhile, The Health and Wellness Center highlighted the story of a peer recovery support specialist who now works with the drug courts. CTI described an innovative prenatal care coordination program called S.A.F.E.R (Safely Advocating for Families Engaged in Recovery).
Policy and Sustainability
The final session highlighted how direct experience with integrated care models can be used to inform state and federal legislative priorities. The session opened with videos from state officials discussing the importance of integration. Speaking from a national perspective, Sam Holcombe noted, “There are many areas within our priorities that we share with NACHC—focusing on workforce, investing in programs that bring more providers into the behavioral health field, increased investments in community health workers and other health support workers, the wellbeing of our workforce; improving and expanding integration of mental health and substance use treatment in primary care settings; and expanding access to telehealth and virtual mental health care options.”
Jeremy Crandall of NACHC noted, “At the federal level, there seemingly has not been as much interest in behavioral health since the Affordable Care Act twelve years ago [until now]. This momentum comes at a time when the health center behavioral health workforce has never had more pressure on it to do more with less... the time is now for folks to make your voices heard with Congress.”
In the face of such pressing needs in Oklahoma and other states, Delta Center grantees are strengthening their partnerships and collective voice to continue their work towards a health policy and a care system that is more equitable and better meets the needs of individuals and families.