Working toward financial sustainability of integrated behavioral health services in a public health care system.

Abstract

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

Social Workers as Behavioral Health Consultants in the Primary Care Clinic

“…Perhaps more financially significant to the greater health system, however, are the cost savings that have been found to be associated with integrated care ( Hawk, Ricci, Huber, & Myers, 2015). Moving forward, BHCs may benefit from greater organizational support if they are able to provide direct, sitespecific evidence of cost savings associated with patients receiving BHC services (for example, less frequent utilization of the emergency department or reduced inpatient readmissions) ( Monson, Sheldon, Ivey, Kinman, & Beacham, 2012).…”

Professional practices, training, and funding mechanisms: A survey of pediatric primary care psychologists.

“…Across the age span, IPC enhances PCP efficiency, generates revenue, and reduces medical costs (Monson, Sheldon, Ivey, Kinman, & Beacham, 2012). Cost savings range from $1700-$2900 per person when mental and physical health needs are addressed together (Chiles, Lambert, & Hatch, 1999).…”

Comparing primary care pediatricians’ perceptions of clinics with and without integrated behavioral health

“…Primary care pediatricians (PCPs) often lack the time and training necessary to meet the increasing demand to effectively address the behavioral health needs of patients within primary care settings (Arndorfer et al, 1999;Williams et al, 2004;Sheldrick et al, 2011). Several barriers have been noted by PCPs with regards to meeting patient behavioral health needs, including the considerable time commitment required and perceived gaps in behavioral health training (Monson et al, 2012). Moreover, PCPs experience lack of financial incentives for the treatment of behavioral health concerns, as the extended time necessary for behavioral health treatment is often not reimbursable within current primary care billing structures (Williams et al, 2004;Meadows et al, 2011).…”