People with behavioral health conditions — mental illnesses and/or substance use disorders — often experience fragmented care and receive less preventive care, while using more acute care. Medicaid spending for this population is more than four times higher than for those without behavioral health conditions, largely as a result of increased spending on physical health care services.

Informed by the growing evidence that clinical integration of physical and behavioral health can improve health outcomes and quality of life as well as reduce health care costs, many states have sought to advance integrated care for Medicaid enrollees with behavioral health needs. A growing number of states are implementing integrated models to address problems of fragmented care and poor health outcomes for individuals with serious behavioral health needs. Many states have transitioned to contracting with managed care or accountable care organizations that are responsible for managing all physical and behavioral health services for Medicaid enrollees. These organizations commonly involve new partnerships between physical and behavioral health plans and providers that can advance the goals of integrated care.

This paper identifies key elements that contribute to successful partnerships between physical and behavioral health organizations. It synthesizes insights from organizational leaders representing Medicaid-based partnerships in four states: Arizona, Arkansas, Colorado, and Oregon. Key elements include:

1. Employing joint-ownership models representing both physical and behavioral health
2. Ensuring stable system transitions for consumers and providers
3. Marrying the expertise of physical and behavioral health partners to create new and enhanced capacities
4. Allowing adequate time for planning and implementation

Through their integration efforts, the profiled states and regions experienced significant transformation in how behavioral and physical health services were managed. These lessons are broadly applicable for health care organizations and policymakers considering how to support successful partnerships to advance physical and behavioral health integration.