CNS' PBHCI project - Community Network Services (CNS), through CNS' PBHCI project provides person- centered BHH services to persons with SMI, diagnosed with or at-risk for a serious medical condition. CNS co-locates and partners with PCPs to develop the processes, protocols, infrastructure, and capacity to integrate and coordinate behavioral health and primary and specialty medical services, within four locations, in Oakland County, MI. Adults 18-65 years old men and women who have SMI and/or co-occurring SUD, enrolled with OCCMHA as a CNS consumer, and have at least one general medical condition, including, but not limited to, Diabetes, COPD, Emphysema, Obesity, Hypertension, or Tobacco Use Disorder. The goal of the CNS PBHCI project is to improve the physical health status of CNS adult consumers who have or are at risk for co-morbid primary care conditions and chronic diseases. The objectives of the program are to (1) improve the health of CNS consumers with SMI and co-occurring SUD; (2) enhance the consumer experience of care, including quality, access, and reliability; and (3) reduce and/or control the per capita cost of care. CNS proposed to serve a minimum of 420 participants during year 1; 1,050 year 2; 1,680 year 3; and 2,000 year 4 a total of 5,250 throughout the lifetime of the project. CNS is committed to continuing care beyond the grant period.