Psychiatrist's changing role in a reformed delivery system: Adding value in accountable care organizations

The introduction of accountable care organizations (ACOs) and recently enacted health care reform legislation have the potential to transform our fragmented health care system, with efforts to advance behavioral health parity. Meeting the ACO triple aim to improve care quality and population health, while lowering health care costs, is not possible without fully integrating mental health and substance use care. This chapter outlines how psychiatrists are uniquely positioned to lead efforts to ensure adequate integration of behavioral health care concerns throughout ACOs, at an individual as well as a population level. Elements within an ACO requiring such behavioral health integration are reviewed, including identifying target populations, and use of health information technology, measurement-based care aimed at mental health and substance use, care management teams, and protocols for monitoring care quality and encouraging cost savings. The many roles of psychiatrists within an integrated care system are also discussed, from developing guidelines for identifying and monitoring behavioral health needs for a defined population to establishing evidence-based practice protocols. Psychiatrists are important members of the health care team, providing supervision, training, and consultation, as well as direct patient care. Experiences from Montefiore Medical Center's ACO initiatives are outlined to provide a model for integrative care procedures and ways in which psychiatry can facilitate collaborative care efforts. Strategies for expanding successful integrative care approaches throughout the health care system are also discussed.