Care Integration in the Patient Protection and Affordable Care Act: Implications for Behavioral Health

  • Croft B
  • Parish S
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Abstract

Individuals with co-occurring serious mental illness and substance use disorders experience a highly fragmented system of care, contributing to poor health outcomes and elevated levels of unmet treatment needs. Several elements in the health care reform law may address these issues by enhancing the integration of physical and behavioral health care systems. The purpose of this paper is to analyze these elements, which fall into three domains: increasing access, restructuring financing and reimburse-ment mechanisms, and enhancing infrastructure. We con-clude with a consideration of the implementation challenges that lie ahead. Passage of the Patient Protection and Affordable Care Act (ACA) is projected to have sweeping impacts on the pro-vision of care for individuals with behavioral and physical health service needs who receive services in the public sector. Much is unknown regarding the ACA's impact on this vulnerable population. In this paper, we critically analyze the integration of behavioral and physical health care for people with serious mental illness and substance use disorders. We begin by briefly outlining the barriers to integrated care faced by individuals with co-occurring disorders. Next, we describe ACA elements that may increase integration in the areas of access, financing, and infrastructure. We close with some considerations of implementation challenges as the nation moves forward. Integration enhances usual care and decision-making for people with medical and behavioral health conditions and is a critical factor in quality, patient experience, and cost (Druss et al. 2001; Peek 2009). It involves people, func-tions, and service sites and entails communication, col-laboration, comprehensiveness, and continuity of care (Horvitz-Lennon et al. 2006). Critical elements of inte-grated care include quality measurement and improvement, the use of health information technology, and patient-centered care (Institute of Medicine [IOM] 2006). Clinical trials of integrated behavioral health and primary care models have demonstrated improvements in physical health (Druss et al. 2001) as well as mental health (Alex-opoulos et al. 2009; Unutzer et al. 2002). People with serious mental illness and substance use disorders have high mortality, poor health outcomes, and face significant barriers to care. They experience high incidence and prevalence of preventable physical health conditions including cardiovascular and respiratory dis-eases, diabetes, and HIV (Blank et al. 2002; Dausey and Desai 2003; Dickey et al. 2002; Horvitz-Lennon et al. 2006). Co-occurring disorders are associated with high levels of both emergency department use and unmet treatment needs (O'Toole et al. 2007). Low employment rates reduce the likelihood that people with co-occurring disorders have employer-sponsored health insurance (Cook et al. 2007). They are therefore more likely to be dually eligible for both Medicare and Medicaid. Those

Author-supplied keywords

  • Behavioral health services
  • Co-occurring disorders Á
  • Integration Á

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Authors

  • Bevin Croft

  • Susan L Parish

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