Kara Hill, MHA, BSSW
Senior Director of Health Integration
Texas Health Institute

Addressing the complex health needs of communities and populations is increasingly important. Improving the health and lives of people from all communities through prevention, early identification, and successful interventions allows people to live long, healthy, and productive lives. Additionally, in 2021, The United States spent over $4.3 trillion on healthcare, with 75% of the cost paid by public and private insurers, health systems, and payers who aim to improve health outcomes and reduce costs. (American Medical Association, 2023) However, the traditional fee-for-service approach has failed to improve quality or reduce costs, making the transformation to whole-person and value-based care necessary. 

Texas Health Institute (THI) is a nonprofit, non-partisan public health institute with a mission to advance the health of all. Our work is focused on three priorities: advancing health systems transformation, strengthening public health infrastructure, and promoting healthy communities. One way that we are advancing health systems transformation is by co-leading the Texas Primary Care Consortium, which aims to strengthen primary care in Texas. 

In the past 10 to 15 years, health systems have implemented various transformation efforts focusing on health integration models to improve the health and lives of people and communities while reducing overall costs. Examples include integrated behavioral health, medical and dental integration, public health and primary care integration, medical-legal partnerships, medical neighborhoods, and healthcare that addresses non-medical drivers of health. These different models of integration seek to provide whole-person care, improve health outcomes, and reduce costs, which supports advancements in value-based care. However, current efforts primarily focus on various models of implementation, lacking an overall strategy to address the underlying systemic barriers of sustainable financing, infrastructure, and workforce implications. 

As a result, different health integration approaches or models have had varying successes and inhibit our ability to achieve scale. For instance, the National Council on Mental Wellbeing states, “Despite extensive progress in recognizing the value of integrated services and demonstrating approaches for implementation, broad uptake of integrated services for people with co-occurring PH/BH/SDOH needs remains much more limited than the need for those services would suggest.” (National Council for Mental Wellbeing, 2022) 

Documenting and measuring improvements are also part of all health integration models, but they segment interventions, measurement tools, and outcomes into different buckets. Viewing health integration differently could realign and reimagine appropriate measurements and outcomes. Some emerging strategies, including the Whole Health Index by Elevance Health, are underway. (Chi, et al., 2023) Nevertheless, the health continuum needs new and innovative strategies to accomplish this goal.

We aim to expand efforts to advance health systems transformation through a new focus on health integration. As a public health institute, we utilize the art and science of improving health through a coordinated effort informed by organizations, professionals, public and private entities, communities, and individuals. With a public health approach, we view health integration as a lens that promotes progress along the health continuum rather than just a model or stand-alone effort of a more extensive system. 

Our proposed approach to health integration involves whole-person care, encompassing all aspects of life that can impact health beyond diagnoses or a few situations. This unique perspective on health integration allows us to develop robust strategies that drive systemic change and create supportive environments for all to thrive. 

Moving upstream, THI will partner with system leaders and advocates to define and describe health integration to support systemic change through a lens that cuts across all integration models using innovative thinking, action, and solutions to advance the health of all. In hopes of supporting further adaptation, adoption, and implementation of various models, we will work with experts to understand cross-sector opportunities and address shared challenges. Some emerging opportunities could include but are not limited to sharing knowledge and information while considering critical changes in the workforce, IT systems and infrastructure, financing, and policy. 

As we begin our work in this space, we value your input and invite you to share your thoughts and ideas to help us better understand your experience in your sector of health integration. We invite you to participate with us to help us deeply understand current realities and envision what else might be possible. Please complete this brief survey if you want a voice in this process. 



American Medical Association. (2023, March 20). Trends in health care spending. Retrieved from AMA: https://www.ama-assn.org/about/research/trends-health-care-spending

Chi, W. C., Overhage, J. M., Sponholtz, T. P., Nguyen, B. T., Brady, P. M., Falconi, A. P., & Johnson, M. P. (2023). The Whole Health Index: A Practical, Valid, and Reliable Tool to Measure Whole-Person Health and Manage Population Health. New England Journal of Medicine, CAT.23.0015.

National Council for Mental Wellbeing. (2022, April 22). The Comprehensive Healthcare Integration (CHI) Framework. Retrieved from National Council for Mental Wellbeing: https://www.thenationalcouncil.org/resources/the-comprehensive-healthcare-integration-framework/