For all kinds of specialist organizations, the market effects of payer preferences for "integration" are presenting formidable strategic challenges. These challenges include fewer behavioral health carve-outs (see State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2018 Annual Update and The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update); health plans contracting with accountable care . . .

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