Delivery System Redesign

Beyond expanding coverage, the Patient Protection and Affordable Care Act (ACA) is designed to improve service quality, health outcomes, and reduce overall health care costs. Primary care, mental health, and substance use disorder (SUD) providers will be encouraged to reorganize themselves to better realize these goals.

This section is designed to provide information pertaining to the new health care delivery systems being considered and implemented both nationally and within the state.

The following links are just a sampling of the materials relating to system delivery. ADP has identified the following as particularly helpful resources, but this does not represent an exhaustive list of the quality reports available. As new material is made available, ADP will update the contents of this page periodically so that it remains current and relevant.

Integrating Primary Care, Mental Health and Substance Use Disorder Services

Mental Health and Substance Use Provider Readiness Assessment
ABSTRACT: This report describes 23 important competencies and strategies necessary to succeed in the new healthcare environment. The tool is structured around five areas that address several internal and external issues. It assists organizations in assessing and redesigning their internal operations to better align with healthcare reform. It is designed to help organizations demonstrate to consumers, healthcare providers, and state policymakers that they are high-performing, quality-focused, and efficient.

Strategic Restructuring for California Community Clinics: Self-Assessment Workbook
ABSTRACT: Strategic restructuring is the establishment of formal partnerships ranging from administrative consolidation to mergers. This workbook offers a variety of ways for clinics and community health centers to strengthen their position and remain viable in the future. This workbook is designed to help clinics determine their readiness to undertake a strategic restructuring process and choose among the various options. The questions are designed to stimulate thinking and discussion about the organization's strengths, assets, and challenges; including, how these traits might be leveraged, strengthened, or addressed by partnering with another organization.

California Integration Policy Initiative (IPI)
Volume I: Report Volume II: Working Papers Volume III: Examples for Dissemination
Abstract: The IPI Report (September 2009) describes the vision, principles, and collaborative care continuum of the Integration Policy Initiative, and makes recommendations to frame the future development of integrated care for California’s Safety Net Population. The report is accompanied by working papers and examples for dissemination.

The Business Case for Bidirectional Integrated Care Report
Abstract: The Report (June 2010) reviews the changing healthcare environment, looks at how integrated care can improve quality outcomes and reduce healthcare costs, and examines how payment reform as a part of health care reform can support a sustainable business case. It summarizes the research that demonstrates that mental health and substance use services can improve quality outcomes and reduce cost, especially when integrated with primary care.

Two-page Talking Points:
Abstract: The article (June 2010) gives a broad overview of how integration can improve outcomes and reduce cost. Accompanying the article is a PowerPoint presentation.


Milbank Report on Evolving Models of Behavioral Health Integration in Primary Care
Abstract: This 2010 report offers an approach for integrating primary care and behavioral health care. The report summarizes the available evidence and various states’ experiences with integration as a means for delivering quality, effective physical and mental health care. The report also provides eight models that represent qualitatively different ways of integrating/coordinating care across a continuum.

Integrating Appropriate Services for Substance Use Conditions in Health Care Settings
Abstract: This July 2010 report details the need and rationale for greater integration as a means for delivering quality, effective physical and mental health care.


Increasing Access to Behavioral Healthcare: Managed Care Options and Requirements
ABSTRACT: States are increasingly relying on managed care to control their Medicaid costs. Nationally, an estimated 16 million additional uninsured people will be added to Medicaid in 2014 under the Affordable Care Act. This report addresses why states should consider Managed Care Organizations and how to best contract with Managed Care Organizations and managed behavioral health care organizations.


Access Redesign Project Summary
ABSTRACT: This report explains how 45 community behavioral health organizations in three states cut consumer wait times by more than half (53 percent), reduced staff time by 40 percent, and saved an average of $222,000 annually. While the project is focused on mental health providers, the improvement techniques can also be utilized by substance use disorder treatment providers.

SAMHSA Description of a Full Array of Mental Health and Substance Use Services
Abstract: This August 2010 brief describes the basic services required for an integrated system of health care and how best to integrate mental and substance use disorders into the health reform implementation agenda. This document also discusses possible changes to the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and the Mental Health Services Block Grant.

Implementing Healthcare Reform: First Steps to Transforming Your Organization
Abstract: This document contains an initial set of recommendations and resources to aid in preliminary health care reform planning efforts. Its purpose is to serve as a resource to help leaders change their organization’s business practices to meet requirements under healthcare reform.

Patient-Centered Medical Homes

Health Policy Brief Medical Homes
Abstract: This September 2010 article describes recent projects that have applied patient-centered medical home concepts, as well as concerns about widespread adoption of the model before results are definitive.

Substance Use Disorders and the Person-Centered Healthcare Home
Abstract: This March 2010 article discusses a variety of questions, benefits and challenges related to Patient Centered Medical Home (PCMH) healthcare.

Accountable Care Organizations

Final Accountable Care Organizations Regulations (Published November 2, 2011):
Abstract: This final rule implements section 3022 of the Affordable Care Act, which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations under the Medicare Shared Savings Program. Under these provisions, providers of services and suppliers can continue to receive traditional Medicare fee-for-service payments under Parts A and B, and be eligible for additional payments if they meet specified quality and savings requirements.

Coalition for Whole Health Comments on Proposed Accountable Care Organizations Regulations (Published June, 7 2011):
Abstract: The following document includes the comments made by substance use disorder (SUD) industry professionals on proposed Accountable Care Organizations regulations. These comments are posted for informational purposes only and do not imply an endorsement from the California Department of Alcohol and Drug Programs. The list was compiled by the Coalition for Whole Health which is a broad coalition of national organizations in the mental health and SUD prevention, treatment, and recovery communities.

Health Policy Brief Accountable Organizations
Abstract: This August 2010 brief discusses how, under the health reform law, Medicare will be able to contract with Accountable Care Organizations (ACOs) to provide care to enrollees. What are they and how will they work?

Accountable Care Organizations in California—Lessons for the National Debate on Delivery System Reform
Abstract: This 2010 paper outlines five overarching aspects of California physician organizations—their organizational structures, payment methods, relationships with health plans, how they promote consumer choice, and the public policy and regulatory constraints they face—and offers ten key lessons for the national ACO debate.

ACOs, Provider Integration, and Impact of Health Reform
Abstract: This December 2010 report details trends in physician-hospital integration and the potential effects of ACO development on the California provider community.

Toward High-Performance Accountable Care: Promise and Pitfalls
Abstract: This September 2010 discussion describes how, under the health reform law, Medicare will be able to contract with ACOs to provide care to enrollees. It also describes what are ACOs and how will they work.

Use of Evidence-based Practices

National Qualify Forum Consensus Standards for the Treatment of Substance Use Conditions—Evidence-based Practices
Abstract: This 2007 study outlines nationally endorsed evidence-based practice (EBP), identifies target outcomes. Additional specifications are provided for what an EBP entails, for whom it is indicated, who performs it, and the settings where it is provided.