For example, practice model 5—reverse colocation—is situated on the continuum at the point of close collaboration in a partly integrated system. It reverses the usual approach in which behavioral health care is integrated into primary care and instead seeks to improve general medical care for persons with serious and persistent mental illness. A primary care physician, physician's assistant, nurse practitioner, or nurse may be stationed part- or full-time in a specialty setting, such as a rehabilitation program or an outpatient psychiatric clinic. Studies of this model are in their infancy, the report notes, but early findings indicate the model's potential to reduce lifestyle risk factors—for example, through screening for hypertension and diabetes. Implementation considerations for reverse colocation include how to address issues such as treatment consents, maintenance of medical records, and referral processes. Mental health case managers in this model will need to develop skills to promote wellness and help patients manage medical conditions. Financial considerations include the potential difficulty of hiring primary care providers, particularly for uninsured and Medicaid patients with multiple comorbid conditions. In addition, mental health agencies may be unable to access codes to bill for medical visits. As an example of this model, the report cites the Community Support Services Center in Akron, Ohio, which serves adults with severe mental illness and which established an integrated primary care clinic and pharmacy in 2008.