TY - JOUR KW - Delivery of Health Care, Integrated KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Mental Disorders/diagnosis/therapy KW - Practice Patterns, Physicians'/statistics & numerical data KW - Qualitative Research KW - United States AU - A. Malâtre-Lansac AU - C. C. Engel AU - L. Xenakis AU - L. Carlasare AU - K. Blake AU - C. Vargo AU - C. Botts AU - P. G. Chen AU - M. W. Friedberg A1 - AB - BACKGROUND: Behavioral health integration is uncommon among U.S. physician practices despite recent policy changes that may encourage its adoption. OBJECTIVE: To describe factors influencing physician practices' implementation of behavioral health integration. DESIGN: Semistructured interviews with leaders and clinicians from physician practices that adopted behavioral health integration, supplemented by contextual interviews with experts and vendors in behavioral health integration. SETTING: 30 physician practices, sampled for diversity on specialty, size, affiliation with parent organizations, geographic location, and behavioral health integration model (collaborative or co-located). PARTICIPANTS: 47 physician practice leaders and clinicians, 20 experts, and 5 vendors. MEASUREMENTS: Qualitative analysis (cyclical coding) of interview transcripts. RESULTS: Four overarching factors affecting physician practices' implementation of behavioral health integration were identified. First, practices' motivations for integrating behavioral health care included expanding access to behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs, and enhancing practice reputation. Second, practices tailored their implementation of behavioral health integration to local resources, financial incentives, and patient populations. Third, barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Fourth, practices described the advantages and disadvantages of both fee-for-service and alternative payment models, and few reported positive financial returns. LIMITATION: The practice sample was not nationally representative and excluded practices that did not implement or sustain behavioral health integration, potentially limiting generalizability. CONCLUSION: Practices currently using behavioral health integration face cultural, informational, and financial barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration. PRIMARY FUNDING SOURCE: American Medical Association and The Commonwealth Fund. AD - RAND Corporation, Santa Monica, California (A.M., C.C.E., L.X., P.G.C.).; RAND Corporation, Santa Monica, California (A.M., C.C.E., L.X., P.G.C.).; RAND Corporation, Santa Monica, California (A.M., C.C.E., L.X., P.G.C.).; American Medical Association, Chicago, Illinois (L.C., K.B., C.V., C.B.).; American Medical Association, Chicago, Illinois (L.C., K.B., C.V., C.B.).; American Medical Association, Chicago, Illinois (L.C., K.B., C.V., C.B.).; American Medical Association, Chicago, Illinois (L.C., K.B., C.V., C.B.).; RAND Corporation, Santa Monica, California (A.M., C.C.E., L.X., P.G.C.).; RAND Corporation, Santa Monica, California, and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.W.F.). BT - Annals of Internal Medicine C5 - Education & Workforce; Financing & Sustainability CP - 2 CY - United States DO - 10.7326/M20-0132 IS - 2 JF - Annals of Internal Medicine LA - eng M1 - Journal Article N2 - BACKGROUND: Behavioral health integration is uncommon among U.S. physician practices despite recent policy changes that may encourage its adoption. OBJECTIVE: To describe factors influencing physician practices' implementation of behavioral health integration. DESIGN: Semistructured interviews with leaders and clinicians from physician practices that adopted behavioral health integration, supplemented by contextual interviews with experts and vendors in behavioral health integration. SETTING: 30 physician practices, sampled for diversity on specialty, size, affiliation with parent organizations, geographic location, and behavioral health integration model (collaborative or co-located). PARTICIPANTS: 47 physician practice leaders and clinicians, 20 experts, and 5 vendors. MEASUREMENTS: Qualitative analysis (cyclical coding) of interview transcripts. RESULTS: Four overarching factors affecting physician practices' implementation of behavioral health integration were identified. First, practices' motivations for integrating behavioral health care included expanding access to behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs, and enhancing practice reputation. Second, practices tailored their implementation of behavioral health integration to local resources, financial incentives, and patient populations. Third, barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Fourth, practices described the advantages and disadvantages of both fee-for-service and alternative payment models, and few reported positive financial returns. LIMITATION: The practice sample was not nationally representative and excluded practices that did not implement or sustain behavioral health integration, potentially limiting generalizability. CONCLUSION: Practices currently using behavioral health integration face cultural, informational, and financial barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration. PRIMARY FUNDING SOURCE: American Medical Association and The Commonwealth Fund. PP - United States PY - 2020 SN - 1539-3704; 0003-4819 SP - 92 EP - 99 EP - T1 - Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States: A Qualitative Study T2 - Annals of Internal Medicine TI - Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States: A Qualitative Study U1 - Education & Workforce; Financing & Sustainability U2 - 32479169 U3 - 10.7326/M20-0132 VL - 173 VO - 1539-3704; 0003-4819 Y1 - 2020 Y2 - Jul 21 ER -