Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care

• DOI: 10.1377/hlthaff.2014.0353
• Publication Date: 2014-10-06T20:03:23Z
• Authors: Valerie A. Lewis; Carrie H. Colla; Katherine Tierney; Arica D. Van Citters; Elliott S. Fisher; Ellen Meara
• Keywords: Accountable Care Organizations; Primary Health Care; Delivery of Health Care, Integrated; Substance-Related Disorders; Mental Disorders; Organizational Innovation; United States; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Models, Organizational; Humans

Accountable care organizations (ACOs) may be well positioned to increase the focus on managing behavioral health conditions (mental health and substance abuse) through the integration of behavioral health treatment and primary care. We used a mixed-methods research design to examine the extent to which ACOs are clinically, organizationally, and financially integrating behavioral health care and primary care. We used data from 257 respondents to the National Survey of Accountable Care Organizations, a nationally representative survey of ACOs. The data were supplemented with semistructured, in-depth interviews with clinical leaders at sixteen ACOs purposively sampled to represent the spectrum of behavioral health integration. We found that most ACOs hold responsibility for some behavioral health care costs, and 42 percent include behavioral health specialists among their providers. However, integration of behavioral health care and primary care remains low, with most ACOs pursuing traditional fragmented approaches to physical and behavioral health care and only a minority implementing innovative models. Contract design and contextual factors appear to influence the extent to which ACOs integrate behavioral health care. Nevertheless, the ACO model has the potential to create opportunities for improving behavioral health care and integrating it with primary care.