Primary Care

Grantee Name

RAND Corporation

Funding Area

Primary Care

Publication Date

February 2016

Grant Amount


Grant Date:

April 2013 – November 2014

Adults with serious mental illness have a wide range of medical, behavioral, social, and other service needs; consequently, comprehensive care for this population may be improved by a system of care in which providers of multiple types work together to ensure that all of these needs are met.

Several major initiatives have been designed in New York to target the health care challenges of adults with mental illness: Substance Abuse and Mental Health Services Administration’s (SAMHSA) Primary and Behavioral Health Care Integration (PBHCI) program, the New York State Office of Mental Health’s (OMH) physical health incentive program, and Medicaid health homes.

Understanding the benefits and challenges of each approach is critical for improving access to and the quality of primary care for adults with serious mental illness. NYHealth awarded a grant to the RAND Corporation (RAND) to explore the shared and distinctive features of these community behavioral health center-based integrated care programs; the policies that facilitate or impede implementation, operation, and sustainability; and innovations in mental health clinics’ approaches to integrated care.

Outcomes and Lessons Learned

  • Conducted site visits, surveys, and interviews to examine in detail the three integrated care approaches underway in New York: PBHCI, OMH’s Medicaid incentives, and Medicaid health homes;
  • Published its findings and recommendations in a report, “An Examination of New York State’s Integrated Primary and Mental Health Care Services for Adults with Serious Mental Illness,” and accompanying issue brief highlighting key findings from the report. The report and brief were widely disseminated and are featured as resources on the SAMHSA/HRSA Center for Integrated Health Solutions website. Summaries of the report also were featured in Crains, Capital Health Care, and the American Association on Health and Disability newsletters;
  • Presented the report’s findings at an NYHealth event, “Behavioral Health and Delivery System Reform: A Conversation with Harold Pincus,” attended by representatives from behavioral health and primary care systems, providers, researchers, New York City and State government officials, and funders; and
  • Briefed highlights of the report to stakeholders at Office of the Assistant Secretary of Planning and Evaluation, SAMHSA, and Centers for Medicare & Medicaid Services.

Findings from the RAND report have implications for the ongoing operation of clinics involved in PBHCI, Medicaid incentives, and health homes. In particular, the report’s findings show how these initiatives could be combined to maximize resources for clinics with significant financial and sustainability concerns. It also outlined the extent of technical assistance needed at clinics to coordinate and adopt complementary funding and resource streams. The results of this research highlight the complexities of implementing programs that depend on the cooperation of multiple State-level agencies, whose traditional operating policies and procedures may be distinct and in conflict with those of the other agencies involved. The National Institute of Mental Health also has recognized the value of this research, funding the RAND team to conduct a multimillion dollar research project on the costs and potential cost-savings associated with each of these models of care.