Literature Collection

OBJECTIVE: Considerable time spent on delivering the collaborative care model (CoCM) for patients with co-occurring opioid use and mental health conditions is not billable under relevant billing codes for Medicare or Medicaid behavioral health integration. In this follow-up study, the authors explored associations between patients' characteristics and the likelihood of receiving unbillable services. METHODS: Billable time was estimated by applying billing code rules to documentation of CoCM delivery from a clinical trial (N=381 patients). Multivariate logistic regressions revealed patient characteristics associated with receiving >15 minutes in ≥1 months of unbillable outreach before CoCM engagement or care time that exceeded code maxima. RESULTS: Overall, 43% of the patients received unbillable outreach, and 59% exceeded billable time. Health system, age, stimulant use, and worry about housing were significantly or marginally associated with exceeding billable time; health system also predicted unbillable outreach. CONCLUSIONS: Policymakers should consider modifying CoCM billing codes to adequately reimburse efforts to engage and serve this complex patient population.

COVID-19 could cause infection in persons with opioid use disorder, increase opioid overdose rates, reverse system-level gains in expanding access to medication for opioid use disorder, halt critical research, and prevent exacting legal reparations against opioid manufacturers. The authors call for urgent action to counteract these risks.

BACKGROUND AND OBJECTIVES: Integrated behavioral health (IBH) delivered in primary care is critical to addressing the growing behavioral health crisis in the United States. COVID-19 prompted changes to the core components of IBH, causing the model to shift. The specifics of how IBH teams adapted and what these adaptations mean for the future of IBH teams in primary care are uncertain. METHODS: We conducted individual interviews with IBH team members using a semistructured interview guide. A purposive convenience sample consisted of primary care clinicians (N=20) from nine states. We used qualitative thematic analysis to code and generate themes. RESULTS: Four themes emerged: (a) permanent changes to the physical structure of the team; (b) increased reliance on technology for team communication; (c) shift in team collaboration, often occurring asynchronously; and (d) telehealth embraced for IBH. CONCLUSIONS: COVID-19 interrupted the originally designed IBH model of team-based care. Changes to the physical proximity of team members disrupted all other components of IBH, requiring adapted workflows, communication via digital channels, virtual team building, asynchronous care coordination, and remote service delivery. Long-term evaluation of these innovations is needed to examine whether shifts in core components impact model efficacy. Training family medicine, primary care, and behavioral health clinicians for these adapted models of IBH will be needed.

Social workers are increasingly working in primary care clinics that provide Integrated Behavioral Healthcare (IBH) in which a patient's physical, behavioral, and social determinants of health are addressed on a collaborative team. Co-location, where care is housed in the same physical space, is a key element of IBH. Yet, little is known about the rate of social workers co-located with primary care physicians (PCPs). To identify national rates of social worker co-location, data were drawn from the Centers for Medicare and Medicaid (CMS) National Plan and Provider Enumeration System (NPPES; n = 232,021 social workers, n = 380,690 PCPs). Practice addresses were geocoded and straight-line distances between practice locations of social workers and PCPs were calculated. More than 26% of social workers were co-located with a PCP. However, in rural settings only 21% were co-located (p < .001). Co-location also varied by PCP practice size, specialty, and state. This study serves as a benchmark of the growth of IBH and continued monitoring of co-location is needed to ensure social work workforce planning and training are aligned with changing models of care. Further, identifying mechanisms to support social work education, current providers, and health systems to increase IBH implementation is greatly needed.

Cardiovascular disease (CVD) commonly coexists with multiple long-term conditions (MLTC), including diabetes, chronic kidney disease, obesity, and mental health disorders. This clustering creates a syndemic burden associated with poorer outcomes, polypharmacy, high treatment burden, and rising healthcare costs. Fragmented, single-disease care models are ill-suited to address this complexity. The WHF roadmap for integrated care in people living with - or at risk of - CVD and MLTC provides a structured framework to support the design, implementation, and scale-up of person-centred, coordinated care models globally. Drawing on current evidence, expert consensus, case studies, and stakeholder surveys, the Roadmap outlines the epidemiological and systemic challenges of MLTC and identifies practical strategies adaptable across high-, middle-, and low-income settings. This Roadmap emphasises multidisciplinary teamwork, aligned financing, digital health infrastructure, workforce development, patient partnership, and robust monitoring and evaluation. By shifting from siloed care to integrated, capacity-sensitive approaches, health systems can improve clinical outcomes, enhance quality of life, reduce avoidable hospitalisations, and build resilience in the face of growing multimorbidity.