To some extent, each program reflects the unique state environment in which it was developed. As one program representative noted, there is not a one-size-fits-all approach to improving the integration of care for this population. In some cases, states tailored their programs to adapt to existing state programs and infrastructure; in other cases, states opted for wholesale system reform, which may have been spurred by other incremental policy changes, or, as in Louisiana, by natural disasters. As a predominantly rural state, North Carolina found that the PCCM model worked well because it was adaptable to either a rural or an urban setting and experienced high participation rates by PCPs. In contrast, the state's comprehensive managed care programs experienced trouble penetrating the rural market and eventually withdrew from the Medicaid program. Vermont, on the other hand, developed its Blueprint for Health program amidst sweeping health care reforms that reorganize health care delivery and financing. Louisiana was on the path to redesigning its system when devastating hurricanes prompted further reforms and greater collaboration between state agencies.
Such contextual factors must be understood in determining whether any of these models could improve care for behavioral health populations in other states. This report summarizes the key features of programs in these states in an effort to provide information that other states and policymakers can use when considering options for financing and delivering more integrated and coordinated care for individuals with behavioral health conditions.