Adults with serious mental illness (SMI) experience higher rates of physical illness and early mortality compared to the general population. Co-morbid SMI and physical illness are also associated with high costs of care, particularly to public payers. To address these disparities, a number of initiatives have promoted the integration of physical health care into mental health treatment settings: for example, the Substance Abuse and Mental Health Services Administration (SAMHSA) Primary and Behavioral Health Care Integration (PBHCI) grants, which provide four years of funding to community mental health centers (CMHCs) to support integrated care for adults with SMI. Despite some early successes, such programs may face considerable barriers to the sustainability of their programs, particularly given grant funding is non-renewable. This paper provides an overview of financing considerations for CMHC-based integrated care programs for adults with SMI, drawing on existing literature as well as anecdotal reports provided by program informants. Variation in program components (e.g., specific services provided, information-sharing capabilities), sources of funding (e.g., grants, reimbursement), and payment models (e.g., fee for service, shared risk/savings) may affect the sustainability of CMHC-based programs. Ongoing implementation of recent policy changes (e.g., Affordable Care Act, and mental health parity legislation) is also likely to affect program sustainability. Current barriers to financing include general limitations in CMHC funding, licensing/credentialing requirements, insufficient reimbursement, lack of coordination among payers and regulatory agencies, and difficulty developing cost-efficient workflow models. Policy changes by multiple stakeholders, including payers, regulatory agencies, and provider organizations, are likely needed to improve physical health care for adults with SMI through integrated care.
Table of Contents
Integrated Care Program Components
Funding Environments for CMHC-Based Integrated Care
Barriers to Financial Sustainability of CMHC-Based Integrated Care