TY - JOUR
AU - E. F. Kyei
AU - M. N. Mumba
A1 - 
AB - BACKGROUND: Medicare serves 65 million Americans aged 65+, with 3.7% having co-occurring mental health and substance use disorders. Despite evidence supporting integrated care, fragmented Medicare policies result in higher readmissions and lower treatment completion rates for this vulnerable population. PURPOSE: To analyze Medicare policies using the Integration Continuum Framework and identify nursing practice and policy implications for older adults with dual diagnoses. METHODS: Systematic review of Medicare policy documents (2010-2023) analyzed through the Integration Continuum Framework across clinical, financial, and administrative dimensions. DISCUSSION: Medicare policies predominantly reflect minimal integration (Levels 1-2). Only 17.3% of beneficiaries with co-occurring disorders receive coordinated care, requiring visits to 3.7 providers across 2.8 facilities compared to 1.9 providers at 1.6 facilities for single diagnoses. The Collaborative Care Model achieves Level 3 integration but excludes substance use disorders, limiting comprehensive care. CONCLUSION: Medicare's fragmented approach creates significant coordination challenges. Nurses are uniquely positioned to bridge these gaps through screening protocols, care navigation, and leadership initiatives. Policy reforms including expanding the Collaborative Care Model to include substance use disorders, eliminating same-day billing restrictions, and streamlining documentation represent pathways toward comprehensive Level 4-5 integration, ultimately improving outcomes for older adults with dual diagnoses.
AD - Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL; Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL. Electronic address: efkyei@ua.edu.; Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL; Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL.
AN - 41005007
BT - Nurs Outlook
C5 - Opioids & Substance Use; Healthcare Disparities; Education & Workforce
CP - 6
DA - Sep 25
DO - 10.1016/j.outlook.2025.102550
DP - NLM
ET - 20250925
IS - 6
JF - Nurs Outlook
LA - eng
N2 - BACKGROUND: Medicare serves 65 million Americans aged 65+, with 3.7% having co-occurring mental health and substance use disorders. Despite evidence supporting integrated care, fragmented Medicare policies result in higher readmissions and lower treatment completion rates for this vulnerable population. PURPOSE: To analyze Medicare policies using the Integration Continuum Framework and identify nursing practice and policy implications for older adults with dual diagnoses. METHODS: Systematic review of Medicare policy documents (2010-2023) analyzed through the Integration Continuum Framework across clinical, financial, and administrative dimensions. DISCUSSION: Medicare policies predominantly reflect minimal integration (Levels 1-2). Only 17.3% of beneficiaries with co-occurring disorders receive coordinated care, requiring visits to 3.7 providers across 2.8 facilities compared to 1.9 providers at 1.6 facilities for single diagnoses. The Collaborative Care Model achieves Level 3 integration but excludes substance use disorders, limiting comprehensive care. CONCLUSION: Medicare's fragmented approach creates significant coordination challenges. Nurses are uniquely positioned to bridge these gaps through screening protocols, care navigation, and leadership initiatives. Policy reforms including expanding the Collaborative Care Model to include substance use disorders, eliminating same-day billing restrictions, and streamlining documentation represent pathways toward comprehensive Level 4-5 integration, ultimately improving outcomes for older adults with dual diagnoses.
PY - 2025
SN - 0029-6554
SP - 102550
ST - Medicare's integration imperative: A policy analysis of care coordination barriers for older adults with co-occurring mental health and substance use disorders
T1 - Medicare's integration imperative: A policy analysis of care coordination barriers for older adults with co-occurring mental health and substance use disorders
T2 - Nurs Outlook
TI - Medicare's integration imperative: A policy analysis of care coordination barriers for older adults with co-occurring mental health and substance use disorders
U1 - Opioids & Substance Use; Healthcare Disparities; Education & Workforce
U3 - 10.1016/j.outlook.2025.102550
VL - 73
VO - 0029-6554
Y1 - 2025
ER -