Payment and parity are key issues in implementing an integration model. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate behavioral health and primary care.
The President’s New Freedom Commission 2003 report, Transforming Mental Health Care in America, resulted in the Federal Action Agenda, which includes direct references to addressing barriers to reimbursement for mental health in primary care. There is a growing body of literature on financing and sustainability issues as they apply to integration.
Integration directly addresses one of the most critical drivers of health care cost: fragmentation.
Increased fragmentation leads to increased cost and decreased quality of care, whereas increased integration leads to decreased cost and improved quality of care; however, this integration requires support from health care providers; health care institutions; and local, state, and Federal Government agencies as well as the involvement of payer sources. In the current health care climate, there are many barriers to providing integrated services, frequently making it cost prohibitive. A big picture approach is necessary in order for integration efforts to be realized. Possibilities include Medicaid incentives for integration, latitude in designing integration efforts with payment innovations that support integrated care, monetary incentives linked to improved health, single payer solutions, and/or universal coverage to eliminate cost shifting related to the uninsured and underinsured.
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