TY - JOUR
AU - J. M. Zhu
AU - S. Chung
AU - M. Giliberti
A1 - 
AB - Given the prevalence of behavioral health disorders in children and adolescents, and ongoing access gaps, clinicians and policymakers have pushed to expand integrated care models in pediatric primary care settings. Despite the evidence surrounding the efficacy of integrated behavioral health models for pediatric populations, uptake has been slow. Practices report many implementation barriers, including stand-up costs, training needs, and inadequate administrative support. In this Commentary, we argue that, perhaps even more fundamentally, ongoing financial challenges are restricting model adoption, scale, and sustainability, particularly for independent and smaller pediatric group practices. Two real-world case studies illustrate several key financial challenges and opportunity costs for such practices, including administrative barriers and lag times in contracting and credentialing behavioral health providers, reimbursement rates that fail to cover the costs of care delivery, opportunity costs for practice revenue, and persistent coding and billing restrictions. Policies aiming to fulfill the clinical promise of integrated behavioral health care must account for these fiscal realities, prioritizing billing and payment alignment with pediatric practices' bottom dollar.
AD - Division of General Internal Medicine, Oregon Health & Science University, Portland, OR 97239, United States.; Trusted Doctors, Fairfax, VA 22033, United States.; Mental Health America, Alexandria, VA 22314, United States.
AN - 40190696
BT - Health Aff Sch
C5 - Financing & Sustainability; Healthcare Disparities
CP - 4
DA - Apr
DO - 10.1093/haschl/qxaf046
DP - NLM
ET - 20250306
IS - 4
JF - Health Aff Sch
LA - eng
N2 - Given the prevalence of behavioral health disorders in children and adolescents, and ongoing access gaps, clinicians and policymakers have pushed to expand integrated care models in pediatric primary care settings. Despite the evidence surrounding the efficacy of integrated behavioral health models for pediatric populations, uptake has been slow. Practices report many implementation barriers, including stand-up costs, training needs, and inadequate administrative support. In this Commentary, we argue that, perhaps even more fundamentally, ongoing financial challenges are restricting model adoption, scale, and sustainability, particularly for independent and smaller pediatric group practices. Two real-world case studies illustrate several key financial challenges and opportunity costs for such practices, including administrative barriers and lag times in contracting and credentialing behavioral health providers, reimbursement rates that fail to cover the costs of care delivery, opportunity costs for practice revenue, and persistent coding and billing restrictions. Policies aiming to fulfill the clinical promise of integrated behavioral health care must account for these fiscal realities, prioritizing billing and payment alignment with pediatric practices' bottom dollar.
PY - 2025
SN - 2976-5390
SP - qxaf046
ST - Integrated behavioral health care in pediatric practices: the dollars don't add up
T1 - Integrated behavioral health care in pediatric practices: the dollars don't add up
T2 - Health Aff Sch
TI - Integrated behavioral health care in pediatric practices: the dollars don't add up
U1 - Financing & Sustainability; Healthcare Disparities
U3 - 10.1093/haschl/qxaf046
VL - 3
VO - 2976-5390
Y1 - 2025
ER -