This document discusses several models for integrated healthcare delivery systems called Integrated Delivery Network Community (IDNC). An IDNC aims to provide seamless care from "Womb to Tomb" through coordination between various providers. The goal is for primary care practices to act as hubs that connect patients to specialists, hospitals, labs, and community resources. Coordinating primary care and behavioral health is also emphasized. Examples provided include a wellness center that integrates various services under one roof, and a health home program that links patients to needed care through care coordinators. The Affordable Care Act and other policies aim to improve access to behavioral health services and their integration with primary care through provisions like increased Medicaid eligibility and parity in insurance

1. This is a business model that is reproducible within each unique Integrated Delivery Network
Community (IDNC). There could be multiple IDNCs within a geographic area. An IDNC is a living,
breathing and evolving healthcare delivery system. All providers within an IDNC have unique roles, but
are dependent upon each other. In concert, they comprise a seamless, comprehensive and evidence-
based continuum of care from “Womb to Tomb.” Improvement of the community health status is the
main priority of each IDNC. Providers, who ingrain their brands, imbed & expand their footprints, foster
strategic partnerships, and increase access to their services will prosper in the IDNC’s perpetual
continuum of care cycle.
The goal of care coordination within an IDNC is to make the primary care practice the hub of all relevant
activity. Care must be coordinated not only within the practice, but between it and community settings,
labs, specialists and hospitals. The responsibility of this Patient-Centered Medical Home (PCMH) is not
to just be informed by community providers and resources, but to reach out and connect in meaningful
ways with other sources of service and link with them, so that information is communicated
appropriately, consistently and without delay. Similarly, primary and behavioral health care integration
is an opportunity under the Affordable Care Act to improve health care quality through systematic
coordination of primary and behavioral healthcare that integrates outpatient behavioral health and
specialty care into care delivery through co-location or referral agreements that link patients with
community resources to facilitate referrals and respond to social service needs. For example, Niagara
Falls Memorial Medical Center recently opened The Niagara Wellness Connection Center, a
revolutionary new coordinated care program that integrates behavioral health, primary care, wellness
services, and community and social support services under one roof. Memorial Vice President and COO
Sheila Kee said, “(Today) we are celebrating a new model of care.”
The center should also address a significant community need - more than 68 percent of adults diagnosed
with a serious mental illness also have companion medical issues and are at greater risk of premature
death, largely due to complications from untreated, preventable chronic illnesses like obesity,
hypertension, diabetes and cardiovascular disease. In addition, mental and substance use conditions
often co-occur. Only 7.4 percent of these individuals receive treatment for both conditions with 55.8
percent receiving no treatment at all. Hak J. Ko, M.D., Memorial’s Medical Director for Behavioral
Health Services, said he applauds the medical center’s administration for its foresight in creating the
center. “It makes my job easier, Ko said. The chronically mentally ill tend to have more problems with
physical health, substance abuse and social issues. Now they will be able to get all of these services in
one location. As a psychiatrist, it will allow me to provide better coordination of care for the patients we
are serving.” These holistic services have decreased the length of time behavioral health patients stay in
the hospital by more than half and dramatically reduced the number of hospital readmissions while
saving Medicaid, Medicare and area health plans $6.4 million. “This will be a model the community will
watch,” said Arthur Wingerter, President of Univera Healthcare.
Another model of health care integration is the health home. The Niagara Falls Memorial Medical
Center Health Home serves individuals who qualify for Medicaid and have a mental health diagnosis or
two chronic health conditions such as asthma, diabetes, obesity or cardiac disease. Care coordinators
link patients to needed care and social services while providing encouragement and support to clients.

2. More than 50 other participating care and service providers collaborate with Memorial Medical Center
in these countywide, state-funded programs. Like the Wellness Connection Center, the Health Home
collaborates with Memorial’s ED Care Coordination Project and Short Stay Intensive Case Management
initiatives to ensure all its patients, including behavioral health clients, receive the quality care and
support they need to get and stay healthy.
The American Recovery & Reinvestment Act of 2009 and other Health Information Technology initiatives
are expediting the digital electronic exchange of health information among area providers through
Health Information Exchanges (HIEs). Individual patient Electronic Health Records (EHRs) will give IDNC
providers the ability to address substance use disorders in primary care settings. Under development
are EHRs with privacy features that allow for the integration of substance use disorder treatment
records into an individual’s EHR. This will simplify the exchange of substance use information between
medical professionals when appropriate, and with patient consent.
The Affordable Care Act (ACA) of 2010 includes substance use disorders as an element of essential
health benefits. The ACA increases the number of people who will be eligible for healthcare under
Medicaid in 2014. By including these benefits in health insurance packages, more healthcare providers
can offer and be reimbursed for these services, resulting in more individuals having access to treatment.
This means that all IDNC providers involved in the care and treatment of patients with MH and CD
illnesses will benefit.
In addition to the Affordable Care Act, the Mental Health Parity and Addiction Equity Act of 2008 will
significantly improve health care for those with mental health challenges and substance use disorders.
This piece of legislation requires insurance groups offering coverage for mental health or substance use
disorders to make these benefits comparable to general medical coverage. Deductibles, copays, out-of-
pocket maximums, treatment limitations, etc., for mental health or substance use disorders must be no
more restrictive than the same requirements or benefits offered for other medical care.
NOTE: Special populations include Military, Veterans, and Families; Police Officers; Anesthesiologists;
Women, Children, and Families; LGBT Individuals; Colleges and Universities; and Native Americans and
Alaskan Indians.