Integration Highway: Bi-Directional Coordination and Integration at the Payor and Delivery System Levels

California, like many states, has a complex safety net healthcare ecosystem of separate funding structures for medical, mental health, and substance use treatment that support separate service delivery systems. This is further complicated by the central role of California’s 58 counties in managing significant portions of payor and provider systems including 57 Medicaid mental health plans, several county-operated health plans, a number of county owned Federally Qualified Health Centers, and over a dozen public hospitals. This complexity combined with a widespread passion for addressing the high morbidity and early mortality of persons with serious mental illness has been a catalyst for advancing primary care and behavioral health integration. 

This presentation provides an overview of how local initiatives supported by statewide resources and technical support from California Institute for Behavioral Health Solutions are enabling communities to craft individually tailored primary care/behavioral health integration solutions that defy the odds. The presentation offers lessons learned about how health plans are working with mental health plans and providers to study the quality and cost impact of integrated care coordination in order to build a business case for sustainability; practices that will help providers work together to braid and blend multiple funding sources that support integrated care; and how to engage foundations and payors to provide seed money to support these efforts.