States are developing accountable care organizations (ACOs) for their Medicaid populations to target health care costs and improve health care quality by better coordinating care for high-need, high-cost patients and reducing inappropriate inpatient and emergency department visits. Many high-need, high-cost Medicaid patients have mental health and substance use issues and are often not well served in the current fragmented health care system. In response, states, including those participating in The Commonwealth Fund-supported Medicaid ACO Learning Collaborative, are increasingly looking to integrate behavioral health into their Medicaid ACO programs to help move the needle on cost and quality.

This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACOs: (1) incorporating behavioral health into payment models; (2) requiring ACOs to report on behavioral health metrics; (3) encouraging ACOs to include behavioral health providers; and (4) providing integration supports. It explores how eight states have incorporated these strategies into their ACO approaches.


This technical assistance tool was developed through CHCS’ Medicaid Accountable Care Organization (ACO) Learning Collaborative, a national initiative made possible by The Commonwealth Fund. The Collaborative is helping states advance new ACO models designed to improve patient outcomes and control costs by shifting accountability for risk and quality to providers.