The following description of six levels of integration can help SBHCs and other health-care-delivery organizations determine their current level of integration, identify the advantages and disadvantages of their current level of integration, and offer insight into what they need to do to become more fully integrated. The information was adapted from the Center for Integrated Health Solutions' A Standard Framework for Levels of Integrated Healthcare. 8
Level 1 Minimal Collaboration. Oral health professionals and primary care health professionals work at separate facilities, use separate systems, and rarely communicate about cases. When communication occurs, it usually results from a particular health professional's need for specific information about a shared patient.
Level 2 Basic Collaboration at a Distance. Oral health professionals and primary care health professionals maintain separate facilities and separate systems. They view each other as resources and communicate periodically about shared patients.
Level 3 Basic Collaboration Onsite. Oral health professionals and primary care health professionals are co-located in the same facility and may or may not share the same practice space. They use separate systems but communicate regularly, especially by phone or e-mail. They meet occasionally to discuss shared patients. Movement of patients between practices occurs most often through a referral process that is more effective than in levels 1 and 2 because the practices are in the same facility. Health professionals may feel they are part of a larger team, but there are no clear guidelines for how the team operates. Most decisions about patient care are made independently by individual health professionals.
Level 4 Close Collaboration with Some System Integration. Oral health professionals and primary care health professionals collaborate more closely, and there is some integration in care through shared systems. A typical model may involve a primary care setting embedding an oral health professional. In an embedded practice, the primary care front desk schedules all appointments, and the oral health professional has access to medical records and enters notes in them. Often, patients with multiple complex health care issues drive the need for consultation, which occurs through personal communication. As oral health professionals and primary care health professionals have more opportunities to share patients, they gain a better understanding of each other's roles.
Level 5 Close Collaboration Approaching an Integrated Practice. Oral health professionals and primary care health professionals collaborate at high levels and are closely integrated. They begin to function as a true team, with frequent personal communication. The team actively seeks system solutions as they recognize barriers to care integration for a broader range of patients. However, some issues, such as the availability of an integrated medical record, may not be readily resolved. Health professionals understand the different roles team members need to play and have started to change their practice and the structure of care to more effectively achieve patient goals.
Level 6 Full Collaboration in a Transformed/Merged Practice. The highest level of integration involves the most significant practice changes. Fuller collaboration between oral health professionals and primary care health professionals has allowed system cultures (whether from two separate systems or from one evolving system) to blur into a single transformed or merged practice. Health professionals and patients view the operation as a single health system treating the whole person. The principle of treating the whole person is applied to all patients, not to targeted groups only.
