TY - JOUR
AU - Sanjay Basu
AU - Bruce E. Landon
AU - John W. Williams
AU - Asaf Bitton
AU - Zirui Song
AU - Russell S. Phillips
A1 - 
AB - Background: New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities. Objective: To evaluate the financial impact for primary care practices of integrating behavioral health services. Design: Microsimulation model. Participants: We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey. Interventions: A collaborative care model (CoCM), involving telephone-based follow-up from a behaviorist care manager, or a primary care behaviorist model (PCBM), involving an in-clinic behaviorist. Main Measures: Net revenue change per full-time physician. Key Results: When behavioral health integration services were offered only to Medicare patients, net revenue was higher under CoCM (averaging $25,026 per MD in year 1 and $28,548/year in subsequent years) than PCBM (-$7052 in year 1 and -$3706/year in subsequent years). When behavioral health integration services were offered to all patients and were reimbursed by Medicare and private payers, only practices adopting the CoCM approach consistently gained net revenues. The outcomes of the model were sensitive to rates of patient referral acceptance, presentation, and therapy completion, but the CoCM approach remained consistently financially viable whereas PCBM would not be in the long-run across practice types. Conclusions: New Medicare payments may offer financial viability for primary care practices to integrate behavioral health services, but this viability depends on the approach toward care integration.
BT - Journal of General Internal Medicine
C5 - Financing & Sustainability
CP - 12
DO - 10.1007/s11606-017-4177-9
IS - 12
JF - Journal of General Internal Medicine
N2 - Background: New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities. Objective: To evaluate the financial impact for primary care practices of integrating behavioral health services. Design: Microsimulation model. Participants: We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey. Interventions: A collaborative care model (CoCM), involving telephone-based follow-up from a behaviorist care manager, or a primary care behaviorist model (PCBM), involving an in-clinic behaviorist. Main Measures: Net revenue change per full-time physician. Key Results: When behavioral health integration services were offered only to Medicare patients, net revenue was higher under CoCM (averaging $25,026 per MD in year 1 and $28,548/year in subsequent years) than PCBM (-$7052 in year 1 and -$3706/year in subsequent years). When behavioral health integration services were offered to all patients and were reimbursed by Medicare and private payers, only practices adopting the CoCM approach consistently gained net revenues. The outcomes of the model were sensitive to rates of patient referral acceptance, presentation, and therapy completion, but the CoCM approach remained consistently financially viable whereas PCBM would not be in the long-run across practice types. Conclusions: New Medicare payments may offer financial viability for primary care practices to integrate behavioral health services, but this viability depends on the approach toward care integration.
PY - 2017
SP - 1330
EP - 1341
EP - 
T1 - Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices
T2 - Journal of General Internal Medicine
TI - Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices
U1 - Financing & Sustainability
U2 - 28900839
U3 - 10.1007/s11606-017-4177-9
VL - 32
Y1 - 2017
ER -