Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Health Federation of Philadelphia (HFP)

Name of Innovative Program: 
Philadelphia Integrated Care Network
Sponsoring Organization
Health Federation of Philadelphia (HFP)
Name of Innovative Program Lead: 
Suzanne Daub
E-mail Address of Innovative Program Lead:
Project Description: 
 HFP has been instrumental in creating an expanding network of integrated Primary Care Behavioral Health practices in the region. HFP has directly organized 21 sites and influenced several others to adopt the practice. The innovative aspects of this initiative include organizing transformation of clinical practice on a network level, creating a workforce training program, spearheading advocacy for payment and policy reform, raising start-up funds, and raising the interest in and visibility of the model on a regional level, working on all elements concurrently and using each element to inform and reinforce the others. That is, development at a systems level paralleled the principles of integrated patient care, using a step-wise approach, a provider-centered orientation, and an integrated strategy.  As a result, the size of the HFP clinical network and the number of Behavioral Health Consultants participating in an ongoing learning community is unique nationally and sustainable locally.
Creativity and Innovation: 
 The creativity involved in this initiative takes the form of effective strategy. HFP recognized that without collective action, the result would not be successful; without collaboration among providers and between HFP and payers/funder right from the start and all along the journey, the buy-in for change would not be as strong; without cultivating champions and nurturing shared leadership the sustainability would be in question; and without training and peer support for the workforce, fidelity to the model and consistency of practice would not be feasible.  As a result, HFP now has a solid network of sites and providers who enjoy a strong collaborative relationship, a successful integrated practice model, and an innovative and stable learning community to foster professional development and model replication. 
 Through the strategic skills of Natalie Levkovich and the collaborative leadership model established within the HFP network, many of the traditional challenges to integration have been met. Adoption of change is difficult; however, through consistent leadership and with providers’ needs and readiness for change setting the pace, the incremental process of evolutionary change has led to implementation of a model at a system level that has been embraced by providers, funders, and policy makers. HFP has emerged as a leader locally and nationally and is viewed as an innovator and expert in advancing the movement of primary care behavioral health integration. Natalie Levkovich, as program director, and Suzanne Daub, as clinical leader,  have been called upon to present at national meetings, policy summits and expert panels; help plan national conferences and regional symposia; contribute to publications; and provide technical assistance to organizations interested in developing integrated programs of clinical care. 
 The work of HFP has been sustained for the past 6 years. As a result of effective advocacy, the clinical work is supported at the site level through earned revenue, which has also been leveraged by some sites to secure additional funding for program expansion/enhancement. Initial funding at the network level was used to support program development and to create training infrastructure and visibility, which, in turn, has sustained the training/technical assistance program through contract revenue, in-kind contributions by network members (i.e., training services), and prudent management. Ongoing advocacy has been incorporated into the general operations of HFP. 
 The integrated model adopted and promoted by HFP has been replicated in 25 sites in the region, expanded from an original cohort of 5 sites. More importantly, the principles of population based care through integration of primary and behavioral healthcare and the core practice standards of BHC/PCP collaboration have been implemented within the context of site-specific adaptations.  It is the fidelity to core principles, not rigid adherence to model protocols that makes the model replicable and acceptable in a variety of settings. Sites participating in the HFP training network include FQHCS, HIV practices (hospital based), and a free clinic. The regional training/community of practice model established by HFP, which has the capacity to support replication, appears to be unique nationally; however, it has gained acclaim as a result of national presentations and could easily be replicated in other regions with modest start up funding and a cluster of engaged providers. 
The clinical practice has been replicated in 29 local sites with 38 BHCs working in medical settings. Primary care behavioral health is now accessible to more than 22,000 traditionally underserved individuals who suffer from co-occurring medical and behavioral disorders. The community of practice established by HFP is the largest multi-agency learning community of BHCs in the nation and services to facilitate professional development and peer support; maintain model fidelity and capacity for replication; and advance advocacy for policy reform and sustainability of integrated practice. Finally, to ensure quality improvement, HFP is leading the development of an entirely novel strategy to define BHC competencies, assess the mastery of those competencies and guide ongoing professional development. This innovation involves development of clinical cases and new rating tools to be used in observation of simulated BHC encounters with trained actor patients.