Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost

Abstract

The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

Primary Care Behavioral Health Integration

“…Cost savings with integrated care application arise from several factors, one of which is more efficient primary care office visits with readily available help for complex psychosocial problems or crises-a significant percentage of the problems encountered in primary care [2][3]10]. Additional cost savings arise from quicker patient stabilization, lower no-show rates for Medicaid patients, and expedited psychiatry consultations [17,23,24].…”

“…O ur current US health care system is undergoing massive structural reform as it moves to meet expectations of a future payment system predicated on value-based outcomes. Integrated care practice models meet this challenge as chronic medical and common behavioral health conditions have been shown to benefit from team-based care approaches that include integrated behavioral health providers [1][2][3]. It is well known that integrated care has been utilized as a model for some North Carolina health care provision, but many clinics that fall short of operating under its tenets may face challenges in meeting both their populations' presenting medical and behavioral health needs, and the trend toward value-based outcomes.…”

“…Integrated care requires a team-based approach in both implementation and execution. This article aims to describe how team-based integrated care is feasible and has the ability to promote the Quadruple Aim, encompassing health care outcomes, patient satisfaction, provider work/life experience, and the cost of care [3,5].…”

“…Services match the pace of primary care and are focused on maximizing patient functionality and self-management, with BHP encounters averaging less than 30 minutes [8,9], providing 1 to 4 consults per patient complaint, and seeing 10 to 15% of patients for longer durations [8]. PCBH has been shown to be effective when targeting about 16% of the clinic's patients seen per day, addressing routine as well as complex patient presentations [3]. Reiter states that PCBH models retain about 90% of behavioral health concerns and refer more acute cases to collaborating specialty mental health providers [10].…”

“…In addition, utilization of PCP visits has been shown to be lower during the BHP's service period and for up to 12 months thereafter with significant improvement over usual care, even for patients with severe and persistent mental illness [11,12]. Furthermore, PCBH in pediatric settings allowed PCPs to serve 42% more patients per day, yielding an additional $1,142 in revenue [3].…”