Ongoing Challenges to Integrating Care in Settings That Serve Patients With Serious Mental Illness and Substance Use Disorder.

Background: People with serious mental illness (SMI) and substance use disorders (SUD) experience difficulties accessing high-quality medical care, despite their elevated risk for chronic health conditions. One proposed solution is the integration of medical and behavioral health services. This study identifies the barriers behavioral health agencies (BHAs) face when attempting to incorporate physical health services for their patients, following a legislative change requiring managed care organizations (MCOs) to oversee all Medicaid-covered medical, mental health, and SUD services. Methods: We conducted semi-structured interviews ( Results: BHAs highlighted the absence of established integrated care models for serving patients with SMI or SUD. Integrating services incurred additional costs, and motivated BHA leaders sought out grants to fund their efforts. MCOs described the limitations to offering alternative payments to BHAs, and BHAs reported that reimbursement rates were insufficient to hire primary care clinicians due to their relatively small size. BHAs expressed a need for reimbursement rates and methodologies better aligned with their patients' needs. Relevance to Clinical Practice: Supporting integrated care within settings that serve patients with SMI and SUD is essential for addressing this population's higher rates of chronic illness and inequities in healthcare access and treatment. Conclusion: Current obstacles suggest that only the most mission-driven BHAs are likely to attempt integration. Engaging states and payers to overcome these barriers is a critical step toward implementing and sustaining integrated care in behavioral health settings.