Sustaining SBIRT in the wild: simulating revenues and costs for Screening, Brief Intervention and Referral to Treatment programs

Abstract

Aims To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments. Design A mathematical model was used to estimate the number of patients needed for revenues to exceed costs. Setting Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists. Participants Practitioners in seven SBIRT programs who received grants from the US Substance Abuse and Mental Health Services Administration (SAMHSA). Measurements Program costs and revenues were measured using data from grantees. Patient flows were measured from administrative data and adjusted with prevalence and screening estimates from the literature. Findings SBIRT can be sustained through health insurance reimbursement in out-patient and emergency department settings in most staffing mixes. To sustain SBIRT in in-patient programs, a patient flow larger than the national average may be needed; if that flow is achieved, the range of screens required to maintain a surplus is narrow. Sensitivity analyses suggest that the results are very sensitive to changes in the proportion of insured patients. Conclusions Screening, Brief Intervention and Referral to Treatment programs in the United States can be sustained by health insurance payments under a variety of staffing models. Screening, Brief Intervention and Referral to Treatment programs can be sustained only in an in-patient setting with above-average patient flow (more than 2500 screens). Screening, Brief Intervention and Referral to Treatment programs in out-patient and emergency department settings can be sustained with below-average patient flows (fewer than 125 000 out-patient visits and fewer than 27 000 emergency department visits).

Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice

“…Acceptance of the CS approach was enhanced when SBIRT staff members were well integrated into their host settings. Although this model provides a useful public health approach in high-volume settings, it may not be ideal in lower volume venues, because there may be insufficient patient flow to support SBIRT specialists [23].…”

“…IHG versus CS). Based on cohort 1 data, Cowell et al [23] used a simulation to model conditions under which SBIRT would be self-sustaining when relying upon public and private insurance reimbursements that cover only some patients. SBIRT could be sustained through health insurance in OP and ED/TC settings in most staffing mixes, but a patient flow larger than the national average may be needed to sustain SBIRT in hospital in-patient settings.…”

Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio

“…These demonstration projects have also recently begun assessing barriers and facilitators to successful SBIRT implementation [ 14 , 15 ], the possibility of financial sustainability from clinical revenue [ 16 , 17 ], and the effectiveness of various team members delivering SBIRT services [ 18 ]. Despite all this research, there is limited evidence for transferring this success from funded demonstration projects to day-to-day primary care office practice, or for beginning SBIRT screening in practices without significant external funding.…”

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross‐site evaluation

“…The first sustainability paper [31] describes the sustainability achieved by the first cohort of SBIRT programs. The second sustainability paper explores financing issues associated with the delivery of SBIRT in the United States [32]. The first systems-level paper [33] explores the effects of US federal SBIRT and other funding and state-level institutional constraints on the activation of SBIRT Medicaid reimbursement codes: a critical systems-level change that could impact SBIRT sustainability in the United States.…”