Literature Collection

This Grantmakers in Health Bulletin article, authored by NYSHealth Senior Program Director Jacqueline Martinez Garcel and NYSHealth Chief Program Learning Officer Kelly Hunt, examines the lack of integrated care for people with co-occurring mental health and substance use disorders and how NYSHealth has supported efforts to transform the systems of care for New Yorkers coping with both conditions.Care for people with co-occurring conditions remains terribly fragmented. Three separate systems exist - health, mental health, and substance use services - to care for each individual problem, each one with its own set of norms, culture, regulations, reimbursement process, and accountability. These siloed systems of care have led to a revolving door for people seeking help. To help transform the systems of care, NYSHealth established the Center for Excellence in Integrated Care (the Center), the first-of-its-kind in New York State. As of the end of 2012, the Center has worked with more than 600 mental health and substance use outpatient sites to help them fully integrate services for patients with co-occurring disorders. The article looks at the approach and impact of integrating care across the two systems, the outcomes to date, and how this can be a model for care management teams.

Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.