Primary Care and Mental Health Integration in Coordinated Care Organizations

Abstract

The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings. The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health? vii

Access to treatment for alcohol use disorders following Oregon's health care reforms and Medicaid expansion

“…The introduction of CCOs was associated with a modest but significant improvement in treatment entry rates for alcohol use disorders. Qualitative data suggest that some primary care clinics added behavioral health workers to primary care teams to facilitate care (Baker, 2017; Kroening-Roche, Hall, Cameron, Rowland, & Cohen, 2017). Finding behavioral health providers trained to treat addiction, however, was challenging (Baker, 2017).…”

“…Qualitative data suggest that some primary care clinics added behavioral health workers to primary care teams to facilitate care (Baker, 2017; Kroening-Roche, Hall, Cameron, Rowland, & Cohen, 2017). Finding behavioral health providers trained to treat addiction, however, was challenging (Baker, 2017). A few CCOs sited primary care practitioners in mental health and addiction treatment settings and used those settings as patient centered primary care homes.…”

“…A few CCOs sited primary care practitioners in mental health and addiction treatment settings and used those settings as patient centered primary care homes. These efforts were limited due to structural barriers including misaligned payment structures, disparate professional cultures, and workforce and clinic capacity (Baker, 2017). While efforts were made to improve access to behavioral health services in primary care settings, the gains in the use of primary care for treatment of alcohol use disorders were modest.…”