Stephen L. Isaacs

The Independent Physician — Going, Going . . .

Stephen Isaacs, Paul Jellinek, and Dr. Walker Ray write that the percentage of U.S. physicians who own their own practice has been declining for at least the past 25 years. This trend raises the question of whether small, independent practices have any future — an important question, since nearly 9 of 10 Americans get their medical care from a physician in a solo or small practice.

New York State Health Foundation: Integrating Mental Health and Substance Abuse Care

Roughly half of all people with severe mental disorders also have substance abuse problems. Yet their care is fragmented: They are treated by either the mental health system or the substance abuse system. In New York State only 10 percent of them receive evidence-based treatment for both conditions. Beginning in 2007 the New York State Health Foundation and two state agencies--the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services--began collaborating on ways to integrate the treatment of people with co-occurring disorders. The state agencies removed financial and regulatory barriers to integrated treatment. The foundation provided funding to establish the Center for Excellence in Integrated Care. The centers goal: provide hands-on assistance in implementing best practices to at least half of the states 1,200 mental health and substance abuse treatment clinics. An evaluation found that the percentage of clinics using best practices doubled after the regulatory and financial changes and the centers intervention. This illustrates the potential that foundations, governments, and nonprofits, working collaboratively, have to improve the care of a neglected and difficult-to-serve population.

California Dreamin' : State Health Care Reform and the Prospect for National Change

California Governor Arnold Schwarzeneggers health care reform bill was rejected overwhelmingly by the state Senate on January 28. Stephen Isaacs and Dr. Steven Schroeder write that this setback in California and the experience in other states illustrate the importance of addressing six obstacles to health care reform.