Integrated System of Care (ISC) Program (2024)

The first of its kind in New Jersey, our ISC Program works with behavioral health providers to manage the complex physical, behavioral and social determinant of health (SDoH) needs of your patients.

How the ISC Program works

The ISC Program uses a virtually integrated care delivery system to provide timely, coordinated and outcome-driven care to our members with serious mental illness (SMI) and substance use disorders (SUD). Each Horizon member who is part of this program is assigned a care coordinator from a behavioral health provider participating in the ISC Program. The care coordinator helps manage a patient's unique behavioral, physical and social health treatment needs with health systems, primary care practices and social services.

  • Which patients will benefit from a referral to the ISC Program?

    Patients with the following signs or symptoms may benefit from a referral to the ISC Program:

    • Patients who you suspect may have chronic and severe mental health conditions including, but not limited to, schizophrenia, major depressive disorder and bipolar disorder. These patients may have distorted thought processes, extreme mood swings from mania to depression, and very poor impulse control. They frequently seek urgent care in a doctor's office, Emergency Room, urgent care center or hospital.
    • Patients who you suspect may need treatment for SUD.
  • What will an ISC Program provider do?

    • Create a treatment plan for a patient's overall health needs following a full assessment.
    • Coordinate the care provided by health systems, primary care practices and social service providers.
    • Help your patients get the services and support they need to achieve and sustain an improved quality of life.
  • How do patients benefit from the ISC Program?

    The ISC Program will help you connect your patients to additional resources beyond their benefits and traditional behavioral health care that address any issues related to SDoH, including access to food, transportation and child care. The program is designed to help patients get and stay healthy with the peace of mind that comes with knowing all their needs are addressed.

    Patient services include:

    • Psychiatric evaluation
    • Medication management
    • Medication Assisted Treatment and Ambulatory Withdrawal Management for SUD
    • Care management to connect patients to support services, including scheduling and providing transportation to medical appointments
    • Care coordination to ensure that ongoing patient care is communicated to the Primary Care Provider
    • Care transition assistance after discharge from inpatient or rehabilitation settings
    • Links to community resources to assist with housing, education, employment, financial stressors, or any other social needs
    • Health education and techniques to motivate patients to engage in self-service management
  • What if my patient is already receiving mental health or substance use treatment?

    The ISC Program can provide added support to those patients already receiving behavioral health care. Our ISC behavioral health partners can work with the patient or treating behavioral health provider to coordinate access to physical health treatment and community resources to address SDoH needs (e.g., referrals, helping patients schedule and keep specialist appointments, transportation, housing and food).

Referring Patients to an ISC Provider Access Center

To make a referral, you or your patient can call one of the participating ISC Provider Access Centers listed below. Please be sure to mention “ISC Program” when speaking to these providers.

Don't hesitate to make a referral even if you are uncertain about the patient's suitability for the ISC Program. Our ISC providers will make a full assessment and get the patient into the most appropriate care to meet their individual needs.

  • Atlantic

    CityISC Provider Access CenterPhone
    Atlantic CityAtlantiCare1-888-569-1000
    HammontonAtlantiCare1-888-569-1000
    NorthfieldLegacy Treatment1-800-433-7365
  • Bergen

    CityISC Provider Access CenterPhone
    ParamusBergen New Bridge1-800-730-2762
    Paramus
    Rochelle Park
    Fair Lawn
    Care Plus NJ1-201-265-8200, ext. 5323
    HackettstownAtlantic Health System/Hackettstown Medical Center1-888-247-1400
  • Burlington

    CityISC Provider Access CenterPhone
    Lumberton
    Moorestown
    Mount Holly
    Westampton
    Oaks Integrated Care1-800-963-3377
    WestamptonCatholic Charities, Diocese of Trenton1-800-360-7711, option 2
  • Camden

    CityISC Provider Access CenterPhone
    Berlin
    Cherry Hill
    Sicklerville
    Oaks Integrated Care1-800-963-3377
  • Cape May

    CityISC Provider Access CenterPhone
    Cape May Court HouseAcenda Health1-844-422-3632, ext. 11469
  • Cumberland

    CityISC Provider Access CenterPhone
    BridgetonInspira1-800-467-7472
  • Essex

    CityISC Provider Access CenterPhone
    BloomfieldCare Plus NJ1-201-265-8200, ext. 5323
    NewarkIntegrity House1-973-623-0600, ext. 7059
    NewarkRutgers UBHC1-800-969-5300
  • Gloucester

    CityISC Provider Access CenterPhone
    Glassboro
    Sewell
    Woodbury
    Acenda Health1-844-422-3632, ext. 11469
    FranklinvilleCatholic Charities, Diocese of Trenton1-800-360-7711, option 2
    Glassboro
    West Deptford
    Woodbury
    Inspira1-800-467-7472
  • Hudson

    CityISC Provider Access CenterPhone
    SecaucusIntegrity House1-973-623-0600, ext. 7059
  • Mercer

    CityISC Provider Access CenterPhone
    Ewing
    Hamilton
    Catholic Charities, Diocese of Trenton1-800-360-7711, option 2
    Trenton
    Lawrenceville
    Trenton
    Oaks Integrated Care1-800-963-3377
  • Monmouth

    CityISC Provider Access CenterPhone
    Aberdeen
    Freehold
    Howell
    Neptune City
    Red Bank
    CPC Integrated Health (formerly CPC Behavioral Health)1-800-250-9811
    Manalapan
    Matawan
    Stress Care of New Jersey1-732-679-4500, option 1
  • Morris

    CityISC Provider Access CenterPhone
    Pompton PlainsAtlantic Health System/Chilton Medical Center1-888-247-1400
    Morristown
    Florham Park
    Atlantic Health System/Morristown Medical Center1-888-247-1400
  • Ocean

    CityISC Provider Access CenterPhone
    Bayville
    Brick
    Manahawkin
    Bright Harbor Healthcare (formerly Ocean Mental Health)1-732-575-1111, option 1
    Lakewood
    Toms River
    Barnegat
    Ocean
    Preferred Behavioral Health1-732-367-4700, ext. 7550
  • Salem

    CityISC Provider Access CenterPhone
    ManningtonLegacy Treatment1-800-433-7365
  • Sussex

    CityISC Provider Access CenterPhone
    NewtonBridgeway Rehabilitation Services1-877-692-5664
    NewtonAtlantic Health System/Newton Medical Center1-888-247-1400
  • Union

    CityISC Provider Access CenterPhone
    UnionBridgeway Rehabilitation Services1-877-692-5664
    Elizabeth
    Cranford
    Trinitas Regional1-908-994-7556
    SummitAtlantic Health System/Overlook Medical Center1-888-247-1400

ISC Program Flyers

Review and share the ISC Program flyers below with your staff and your patients and their families, as appropriate.

ISC flyers for you and your staff

  • Provider Flyer-ISC
  • Provider Flyer-ISC Youth

ISC flyers to share with your patients

  • Member Flyer-ISC-English
  • Member Flyer-ISC-Spanish
Integrated System of Care (ISC) Program (2024)
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