Why We Need Dedicated Integrated Care Directors — At Every Level of the Health System

If you’ve spent any time in the integrated care space, you know the pattern: A grant funds a pilot. A bold health plan tries something innovative. A state rolls out a value-based model. Then people move on, funding dries up, the next crisis takes priority and we forget the lessons we just learned. Institutional knowledge evaporates, relationships fray, and we re-invent the wheel five years later. We can’t build an efficient or sustainable system this way.

What’s missing? Dedicated leadership embedded within key structures of our health system; people whose job it is to bridge gaps, align incentives, carry lessons forward, and serve as connective tissue between policy, payer, and practice.

So here’s the proposal:

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1. Federal Director of Integrated Care

Where this role should live:

Office of the Assistant Secretary for Health (OASH), under HHS—ideally integrated with the Office of Disease Prevention and Health Promotion or Mental Health and Substance Use.

Purpose:

Lead the national strategy for integrated care across behavioral and physical health, support cross-agency alignment, and ensure federal efforts reflect best practices.

Key Responsibilities:

• Develop and oversee a national integrated care strategy across CMS, HRSA, SAMHSA, AHRQ, and NIH.
• Maintain an interagency working group on integrated care to align funding, research, and implementation efforts.
• Create federal guidance documents for states and health systems on integrated care models (e.g., PCBH, CoCM, bidirectional care).
• Build and maintain a national dashboard of integrated care metrics and implementation.
• Coordinate national workforce initiatives with HRSA to train BHCs, care managers, and consulting psychiatrists.

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2. State Director of Integrated Care

Where this role should live:

State Departments of Health and Human Services (DHHS), within the Medicaid and Behavioral Health divisions.

Purpose:

Translate national strategy to state-specific implementation, align public programs (Medicaid, behavioral health, public health), and ensure sustainability of integrated care efforts.

Key Responsibilities:

• Align Medicaid, behavioral health, and public health funding streams to support integrated models.
• Work with MCOs to build integrated care standards and incentive programs.
• Develop state-level certification or recognition programs for integrated care providers and clinics.
• Partner with academic institutions to expand state-based training pipelines for integrated care roles.
• Track integrated care access and outcomes across the state, especially in underserved communities.

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3. Payer Director of Integrated Care

Where this role should live:

Within every major payer (public or private), reporting to both behavioral health and medical leadership.

Purpose:

Ensure internal integration between mental health and physical health benefits and manage external partnerships with integrated providers.

Key Responsibilities:

• Design and manage integrated care reimbursement models (e.g., bundled payments, per-member-per-month rates).
• Serve as a liaison between behavioral health and primary care provider networks.
• Develop infrastructure to support data sharing and outcome measurement across care domains.
• Identify high-value interventions and disseminate learnings across provider partners.
• Evaluate ROI and guide reinvestment in integrated models that improve population health.

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Why This Matters Now

We’re asking our health system to take on increasingly complex challenges: behavioral health crises, chronic disease, substance use, health inequities. However, we continue to treat the system itself as if it doesn’t need structural change. We build new programs on foundations that can’t hold them. We rely on heroic efforts by individuals instead of sustainable roles with clear mandates.

The point of these positions is simple: institutional memory, cross-sector alignment, and accountability for results.

Without someone whose full-time job is to build and maintain integrated systems, we will keep losing the lessons we learn and wasting the resources we invest. We’ll keep mistaking pilot projects for progress. We need embedded leadership that understands both behavioral health and primary care, can speak both payer and provider languages, and can build systems that last.

If we’re serious about equity, cost-efficiency, and outcomes in healthcare these roles are not luxuries. They’re infrastructure.

Let’s stop making the same mistakes.

Photo by Rendy Novantino on Unsplash