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Tackling Integrated Care Is Key to Health Reform

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It's a staple of health policy discussions these days: 20% of patients account for 80% of all health care costs. Within that 20%, those who have the highest costs suffer from multiple chronic illnesses. One of the most challenging examples is individuals with both mental health and substance use disorders. Unless we figure out how to more efficiently care for these high-need patients, expanding access to health care--no matter the approach--will become unaffordable.

Two recent articles in the Washington Post demonstrated all too clearly that our system for treating individuals with both mental health and substance use disorders is entirely ineffective. Of the estimated 7 million individuals nationwide suffering from co-occurring mental health and substance use disorders, only 10% receive the type of evidence-based treatment that addresses both disorders and actually improves their health.

This failure is costing us--to the tune of $100 billion annually in lost productivity as well as huge costs associated with inpatient care and re-hospitalization.

As we talk about health care reform and cost containment, behavioral health care must be part of the discussion.

Like primary and specialty health care, behavioral health care requires major improvements, and reforming care for individuals with co-occurring disorders doesn't have to break the bank. But it does require us to get to the root of the issue: our system's failure to support providers to treat both problems in an integrated way.

Despite an overlap in the patient population they serve, mental health and substance use providers--encouraged by past approaches to payment and regulation--often operate in silos, with integration of care being the exception and not the rule. Even when individuals are treated for both disorders, inconsistencies in accepted practices between mental health and substance use service providers often produce ineffective outcomes. The results for the 90% who don't get proper care are disastrous: their disorders worsen, their quality of life is reduced, and far too many lives end prematurely.

The current focus on health reform and the need to create a more coordinated and cost-effective health care system makes this an ideal time to ensure that integrated care for individuals with both mental health and substance use issues becomes the norm by:

• Lifting regulatory restrictions that prevent simultaneous treatment of both disorders.

• Streamlining the clinical protocols used to identify, diagnose, and treat co-occurring disorders by both mental health and substance use providers to eliminate conflicting practices and align treatment regimens.

In New York, an initiative is underway to align efforts across the public and private sectors to address integrated care. The Center of Excellence for the Integration of Care (CEIC) was created by the New York State Health Foundation to focus on the latter goal, while the New York State Office of Mental Health and the Office of Alcohol and Substance Abuse Services are addressing the former.

Specifically, CEIC was established to integrate care at the state's 1,223 licensed mental health and substance abuse outpatient treatment centers by providing training and helping these providers adopt standard protocols to identify, diagnose, and treat patients who have co-occurring disorders. When put into practice, this will collapse the barrier for treatment between the two areas and make the most effective evidence-based treatment practices standard statewide. Most important, it will ensure that there is "no wrong door" for anyone seeking care for co-occurring disorders.

While CEIC's work is still in its infancy, it's already making promising headway, and by 2014 expects to have significantly raised the number of patients with co-occurring disorders receiving integrated treatment. And, that jump is expected to save New York millions in lost productivity, re-hospitalizations, and related health care costs.

New York State is fortunate to have forward-thinking leaders at its Office of Mental Health and Office of Alcoholism and Substance Abuse Services. They are committed to restructuring reimbursement and regulation to encourage better care for people with both mental health and substance use disorders. This is an area where our state can be a leader in helping the nation adopt strategies to improve care for this vulnerable population. Integrating care for this population provides a valuable lesson as we continue to debate the best ways to reform our health system.