Southcentral Foundation’s Playbooks
Southcentral Foundation was one of the first organizations to implement integrated primary care (also known as team-based or multidisciplinary care), pioneering its Integrated Care Teams (ICTs) as part of the rollout of the relationship-based Nuka System of Care in the late 1990s.
Now, in order to support sustainability of our own transformation, as well as to help other health care organizations implement and improve integrated care teams, SCF has created the Integrated Care Teams Playbook and the Behavioral Health Integration Playbook, which are based on SCF’s experiences and lessons learned in implementing these systems. The playbooks are organized using SCF’s READI model, which SCF uses in other areas, including improvement and innovation, and consulting with outside organizations.
Integrated Care Teams Playbook
Southcentral Foundation’s Integrated Care Teams Playbook includes information about all aspects of implementing and sustaining integrated care teams, including but not limited to team composition, roles and responsibilities of each member, improving access for customer-owners, workload balance, empanelment, facility considerations, data considerations, improvement and innovation, and more. This information comes from SCF subject matter experts who have been with SCF since before ICTs were established and were key figures in SCF’s system transformation. The playbook also includes tools SCF still uses in operating its ICTs today.
Integrated Care Teams Playbook: Supplement on Empanelment
As discussed in the Integrated Care Teams Playbook, empanelment is the pairing of customer- owners and Integrated Care Teams. SCF does not assign customer-owners to care teams (except in the case of newborns; more information on this is included in the newborn empanelment section), but rather allows them to choose their care teams. This supports the building of relationships between customer-owners and their care team. If possible, all customer-owners your organization serves should be empaneled to a care team, and should always be seen by that care team and work with that team on their health goals and needs.
This supplement contains additional information related to empanelment.
Behavioral Health Integration Playbook
Southcentral Foundation’s Behavioral Integration Playbook includes information about how to set up systems for integrated behavioral health in a health care organization. The playbook discusses many aspects of integration, including but not limited to roles and responsibilities of integrated behavioral health consultants, approaches to clinical behavioral work, workload balance, facility considerations, data usage, charting, how to ensure access to behavioral services, and more. The information in the playbook comes from SCF subject matter experts who were part of SCF’s original implementation of integrated behavioral services.
