title: Few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care.
abstract: 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.
authors.affiliation: Valerie A. Lewis (valerie.lewis@gmail.com) is an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, in Lebanon, New Hampshire.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lewis
authors.affiliation: Carrie H. Colla is an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center, Geisel School of Medicine.
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Colla
authors.affiliation: Katherine Tierney is a health policy fellow at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tierney
authors.affiliation: Arica D. Van Citters is a researcher at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine.
authors.forename: Arica D
authors.initials: AD
authors.lastname: Van Citters
authors.affiliation: Elliott S. Fisher is director of the Dartmouth Institute for Health Policy and Clinical Practice and a professor of medicine and of community and family medicine at the Geisel School of Medicine.
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
authors.affiliation: Ellen Meara is an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts.
authors.forename: Ellen
authors.initials: E
authors.lastname: Meara
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D017146:Models, Organizational; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D014481:United States
keywords: Cost of Health Care; Health Reform; Mental Health/Substance Abuse; Organization and Delivery of Care; Primary Care