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Behavioral Health Series: ACOs Leading the Way in Integrating Behavioral Health

How ACOs are Revolutionizing the Integration of Physical and Behavioral Healthcare


October 5, 2023 – The healthcare landscape has witnessed transformative changes in recent decades. One significant shift is the growth of Accountable Care Organizations (ACOs). According to CMS, an ACO is a group of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. These organizations are designed to improve the quality of care while reducing costs.

While ACOs are not a new concept, they are now at the forefront of integrating behavioral health into care plans. In this blog, we’ll delve deep into the ACO framework, its historical context, and how ACOs are working to integrate behavioral health into traditional patient care. 

The History of ACOs and Integrated Behavioral Healthcare

ACOs are a product of the Affordable Care Act. They were conceived with the primary goal of enhancing care coordination to in turn improve patient outcomes and minimize costs. The structure of ACOs encourages providers to shift away from a volume-driven, fee-for-service (FFS) approach to a value-based care paradigm where better outcomes are rewarded. This change requires addressing both immediate medical needs but also the underlying behavioral health issues that may exacerbate or even cause certain health conditions.

Why does integrating behavioral health and physical health truly matter? Historically, the segregation of behavioral health from mainstream medicine has often led to fragmented care. This fragmentation and lack of coordination is not only inefficient and more costly but can also have a negative effect on patient outcomes. Recognizing this critical gap, CSM began to push the idea of an Integrated Care Model in 2012 and has since continually emphasized the importance of integrated care.

As ACOs gained traction and CMS continued to push, an increasing number of these organizations began actively integrating behavioral health services into their models. A whole-person care approach that addresses both medical and behavioral health needs, can lead to improved quality of care, better patient well-being, reduced hospital readmissions, and, in turn, decreased overall costs. 

The Benefits of Behavioral Health Integration in ACOs

The integration of behavioral health into ACOs is an essential evolution into whole-person and value-based care. But why is it so important, and what distinct advantages does this integration bring? Let’s dive into it…

  • Comprehensive Care Leading to Better Health Outcomes: Behavioral health plays an integral role in an individual’s overall well-being. Many physical health conditions, such as diabetes or heart disease, have behavioral components or comorbidities. Addressing behavioral health can aid in better care management and even prevention of such conditions.
  • Enhanced Efficiency Leading to Lower Costs: While patient well-being is the priority, the financial side of things cannot be ignored. Integrating behavioral health can lead to substantial cost savings for several reasons. First, treating behavioral health disorders in their early stages can prevent expensive interventions later. In addition, when behavioral and physical health issues are addressed concurrently, there’s a reduction in hospital readmissions, emergency department visits, and other high-cost care scenarios.
  • Improved Consumer Satisfaction: Individuals often find it challenging to navigate the fragmented healthcare landscape and ACOs bring everything under one roof. This seamless integration where both their physical and mental health needs are addressed under one umbrella can lead to increased satisfaction and the ability to find and access care. 
  • Fostering a Culture of Preventive Care: Focusing on behavioral health can also help instill a culture of preventive care. Addressing lifestyle choices, stressors, and mental health can prevent the onset of several physical health ailments. An integrated approach can guide patients towards healthier lifestyle choices and proactive health management that leads to better health outcomes and lower costs.

As you can see, the integration of behavioral health into ACOs is not merely a strategic choice—it’s an informed approach that recognizes the intricate interplay between physical and behavioral health. As we strive for health equity and optimal outcomes, it is essential to understand that neglecting one aspect of care can have negative effects on the other. 

Strategies and Mechanisms for ACOs Integrating Behavioral Health Care

As the healthcare landscape continues to evolve and some states have even begun mandating that they integrate behavioral health services, ACOs are adopting innovative approaches to integrate behavioral health services. This not only enhances the quality of care but also ensures a whole-person approach to care. 

One of the most common ways that ACOs are integrating behavioral health is through the co-location of service. This involves bringing behavioral health professionals under the same roof as primary care providers. This co-location simplifies the referral process, fosters seamless communication between professionals, and most importantly, reduces barriers for those who may feel stigmatized seeking standalone mental health services. Another reason this approach is common is that providers know early detection is key. By mandating regular behavioral health screenings during primary care visits, symptoms can be identified earlier, and individuals can be directed to behavioral health providers in the same facility to make things seamless. 

Another way that ACOs are integrating behavioral health is through technology. One example of this is Atlantic Health System, which operates across New Jersey, Pennsylvania, and New York. To help patients get access to care, they teamed up with digital health company NeuroFlow and now use a collaborative care model to integrate behavioral. The partnership allows providers to use the registry and caseload management tools provided by NueroFlow so they can track and measure member progress and pinpoint individuals that might need services. Members can also tap into the technology for education, care plans, motivational tools, and even to access virtual behavioral health providers. This is a great example of how technological advances have led to increased integration of behavioral health, especially telehealth expanding access to care. 

ACOs are also turning to home-based approaches for integrating behavioral health. This is most often done through partnerships with community-based organizations. An example of this is Innovive in Massachusetts that has teamed up with ACOs to provide in-home care to individuals with serious mental illness (SMI). The model combines physical and behavioral health needs as Innovive also offers physical therapy, occupational therapy, and home health aides. While Innovive is not an ACO, it shows how ACOs can benefit from partnering with outside organizations to provide whole-person integrated care to boost overall health outcomes. 

Finally, ACOs are also leveraging value-based care models tailored to facilitate integration. By design, ACOs utilize value-based payments, so it’s only natural to use VBP to facilitate the integration of behavioral health into care plans. Primary care groups in ACOs are heavily invested in VBP models. With such a strong tie between physical and behavioral health, it only makes sense that ACOs incentivize the full spectrum of health care services since they are all intertwined. ACOs are doing this through bundled payments for certain mental health conditions, performance incentives for providers based on health outcomes, and shared savings models that reward holistic care over episodic treatments.

As you can see, through strategic initiatives, technological advances, community partnerships, and value-based payment models, ACOs are taking different approaches to ensuring that behavioral health is no longer a core component of comprehensive care.

Advocates Perspective

The trajectory of modern healthcare is evolving beyond the siloed treatment of physical and behavioral health. The shift towards integrating behavioral health into ACO models exemplifies this evolution. As ACOs blend physical health with behavioral health strategies, the whole-patient care view is ushering in a new era of care. With value-based care models, strategic community collaborations, and technological integrations, ACOs pivoting towards integration that promises better patient outcomes and reduces overall costs. This integration is essential for consumers as addressing behavioral health challenges early and head-on can prevent exacerbated health crises in the future, leading to better health outcomes and improved patient satisfaction.


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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.