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Financing the Primary Care Behavioral Health Model

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Abstract

The PCBH model of integrated care blends behavioral health professionals into the primary care team, thereby enhancing the scope of primary care and expanding the range of services provided to the patient. Despite promising evidence in support of the model and a growing number of advocates and practitioners of PCBH integration, current reimbursement policies are not always favorable. As the nation’s healthcare system transitions to value-based payment models, new financing strategies are emerging which will further support the viability of PCBH integration. This article provides an overview of the infrastructure necessary to support PCBH practice; reviews the current PCBH funding landscape; discusses how emerging trends in healthcare financing are impacting the model; and provides a vision for the viability of the PCBH model within the value-based financing of our healthcare system in the future.

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References

  • Abrams, M., Nuzum, R., Mika, S., & Lawlor, G. (2011). Realizing health reform’s potential: How the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers. The Commonwealth Fund, 1, 1466.

    Google Scholar 

  • Ader, J., Stille, C. J., Keller, D., Miller, B. F., Barr, M. S., & Perrin, J. M. (2015). The medical home and integrated behavioral health: Advancing the policy agenda. Pediatrics. https://doi.org/10.1542/peds.2014-3941.

    Article  PubMed  Google Scholar 

  • Adler, B., Biggs, W. S., & Bazemore, A. W. (2013). State patterns in medical school expansion, 200–2010: Variation, discord, and policy priorities. Academic Medicine, 88(12), 1849–1854. https://doi.org/10.1097/ACM.0000000000000037.

    Article  PubMed  Google Scholar 

  • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care health, and cost. Health Affairs, 27, 759–769. https://doi.org/10.1377/hlthaff.27.3.759.

    Article  PubMed  Google Scholar 

  • Blumenthal, D., & Abrams, M.K. (2016). Tailoring complex care management for high-need, high-cost patients. Journal of the American Medical Association, 316, 1657–1658.

    Article  PubMed  Google Scholar 

  • Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. https://doi.org/10.1370/afm.1713.

    Article  PubMed  PubMed Central  Google Scholar 

  • Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (2008). Integration of mental health/substance abuse and primary care. AHRQ Publication No. 09-003. Rockville, MD: Agency for Health Research and Quality.

  • Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The impact of psychological interventions on medical cost offset: A meta-analytic review. Clinical Psychology, 6, 204–220. https://doi.org/10.1093/clipsy.6.2.204.

    Article  Google Scholar 

  • Corso, K., Hunter, C., Dahl, O., Kallenberg, R., & Manson, L. (2016). Integrating behavioral health in the medical home: A rapid implementation guide. Phoenix: Greenbranch Publishing.

    Google Scholar 

  • Cummings, N. A., & VandenBos, G. R. (1981). The twenty years Kaiser-Permanente experience with psychotherapy and medical utilization: Implication for national health policy and national health insurance. Health Policy Quarterly, 1, 159–175.

    PubMed  CAS  Google Scholar 

  • Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act will strengthen the nation’s primary care foundation.. Journal of General Internal Medicine, 26, 1201–1203.

    Article  PubMed  PubMed Central  Google Scholar 

  • Freeman, D. (2011). Blending behaviorists into the patient centered healthcare home. In W. O’Donohue & N. Cummings (Eds.), Understanding the Behavioral healthcare crisis: The promise of integrated care and diagnostic reform. New York: Routledge.

    Google Scholar 

  • Friedberg, M. W., Rosenthal, M. B., Werner, R. M., Volpp, K. G., & Schneider, E. C. (2015). Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care. Journal for the American Medical Association Internal Medicine. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2296117.

  • Funderburk, J. S., Fielder, R. L., Demartini, K. S., & Flynn, C. A. (2012). Integrating behavioral health services into a university health centers: Patient and provider satisfaction. Families, Systems and Health, 30, 130–140.

    Article  PubMed  Google Scholar 

  • Healthcare Effectiveness data and Information Set (HEDIS) (2018). Retrieved from https://www.ncqa.org/hedis-quality-measurement/hedis-2018.

  • Hill, J. (2015). Behavioral health integrations: Transforming patient care, medical resident education, and physician effectiveness. The International Journal of Psychiatry in Medicine, 50, 36–49.

    Article  PubMed  Google Scholar 

  • Hubley, S. H., & Miller, B. F. (2016). Implications of healthcare payment reform for clinical Psychologists in medical settings. Journal of Clinical Psychology in Medical Settings, 23, 3–10. https://doi.org/10.1007/s10880-016-9451-1.

    Article  PubMed  Google Scholar 

  • Hunter, C. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (2017) Primary Care Behavioral Health (PCBH) model research: Current state of the science and a call to action. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-017-9512-0.

    Article  PubMed  Google Scholar 

  • Institute of Medicine. (2007). Rewarding provider performance: Aligning incentives in medicare. Washington, DC: The National Academies Press. https://doi.org/10.17226/11723.

  • Kathol, R., Perez, R., & Cohen, J. (2010). The integrated case management manual: Assisting complex patients regain physical and mental health (1st edn.). New York, NY: Springer Publishing.

    Google Scholar 

  • Kathol, R. G., deGruy, F., & Rollman, B. L. (2014). Value-based financially sustainable behavioral health components in patient centered medical homes. Annals of Family Medicine, 12(2), 172–175. https://doi.org/10.1370/afm.1619.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kellerman, R., & Kirk, L. (2007). Principles of the patient-centered medical home. American Family Physicians, 76(6), 774–775.

    Google Scholar 

  • Koller, C. F., & Khullar, D. (2017). Primary care spending rate-a lever for encouraging investment in primary care. New England Journal of Medicine, 337, 1709–1711. https://doi.org/10.1056/NEJMp1709538.

    Article  Google Scholar 

  • Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., & Austin, K. (2016). The impact of integrated psychological services in a safety net Primary care clinic on medical utilization. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.22367.

    Article  PubMed  Google Scholar 

  • Markovitz, A. R., Alexander, J. A., Lantz, P. M., & Paustian, M. L. (2015). Patient-Centered Medical Home Implementation and Use of Preventive Services: The Role of Practice Socioeconomic Context, Journal for the American Medical Association Internal Medicine. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2110999.

  • Melek, S., Norris, D., & Paulus, J. (2014). Economic impact of integrated behavioral medicine, implications for psychiatry. American Psychiatric Association website. http://www.psychiatry.org/integratedcare.

  • Miller, B. F., Ross, K. M., Davis, M. M., Melek, S. P., Kathol, R., & Gordon, P. (2017). Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist, 72(1), 55–68.

    Article  PubMed  Google Scholar 

  • National Committee on Quality Assurance (2014). New version of PCMH and retirement of 2011. Retrieved from http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/NewVersionofPCMH.aspx.

  • Nielsen, M., Olayiwola, J. N., Grundy, P., & Shaljian, M. (2014). The patient-centered medical home’s impact on cost and quality: An annual update on the evidence, 2012–2013. Patient-Centered Primary Care Collaborative. Retrieved from https://www.pcpcc.org/resource/medical-homes-impact-cost-quality.

  • Obama, B. (2016). United States health care reform: Progress to date and next steps. Journal of the American Medical Association, 315, 525–532.

    Article  Google Scholar 

  • Patient Protection and Affordable Care Act. (2010). 111th United States Congress. Washington, D.C.: United State Government Printing Office.

    Google Scholar 

  • Peikes, D. N., Reid, R. J., Day, T. J., Cornwell, D. D. F., Dale, S. B., Baron, R. J., … Shapiro, R. J. (2014). Staffing patterns of primary care practices in the comprehensive primary care initiative. The Annals of Family Medicine, 12(2), 142–149. https://doi.org/10.1370/afm.1626.

    Article  PubMed  Google Scholar 

  • Porter, M. E., & Kaplan, R. S. (2016). How to pay for health care. Harvard Business Review. pp. 88–100.

  • Press, M. J., Howe, R., Schoenbaum, M., Cavanaugh, S., Marshall, A., Baldwin, L., & Conway, P. H. (2016). Medicare payment for behavioral health integration. New England Journal of Medicine, 376, 405–407. https://doi.org/10.1056/NEJMp1614134.

    Article  PubMed  Google Scholar 

  • Ratzliff, A., Unutzer, J., Katon, W., & Stephens, K. (2016). Integrated care: Creating effective mental and primary health care teams. Hoboken, NJ: Wiley.

    Google Scholar 

  • Reiter, J. T., Dobmeyer, R. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-017-9531-x.

  • Rosenthal, T. C. (2008). The medical home: Growing evidence to support a new approach to primary care. Journal of the American Board of Family Medicine, 21(5), 427–440. https://doi.org/10.3122/jabfm.2008.05.070287.

    Article  PubMed  Google Scholar 

  • Runyan, C. (2011). Psychology can be indispensable to health care reform and the patient-centered medical home. Psychological Services. https://doi.org/10.1037/a0023454.

    Article  Google Scholar 

  • Runyan, C., Fonseca, V. P., Meyer, J. G., Oordt, M. S., & Talcott, G. W. (2003). A novel approach for mental health disease management: The Air Force Medical Service’s interdisciplinary model. Disease Management, 6, 179–187.

    Article  PubMed  Google Scholar 

  • Savage, A., Lauby, T., & Burkard, J. F. (2014). Examining selected patient outcomes and staff satisfaction in a primary care clinic at a military treatment facility after implementation of the patient-centered medical home. Military Medicine, 178(2), 128–134.

    Article  Google Scholar 

  • Scharf, D. M., Eberhart, N. K., Schmidt-Hackbarth, N., Horvitz-Lennon, M., Beckman, R., Han, B. … Burnam, M. A. (2014). Evaluation of the SAMHSA primary and behavioral health care integration (PBHCI) grant program. Final report (Task 13). RAND Corporation. Retrieved from http://www.rand.org/pubs/research_reports/RR500/RR546/RAND_RR546.pdf.

  • Schroeder, S. A., & Frist, W. (2013). Phasing out fee-for-service payment. New England Journal of Medicine, 368, 2029–2032. https://doi.org/10.1056/NEJMsb1302322.

    Article  PubMed  CAS  Google Scholar 

  • Sia, C., Tonniges, T. F., Osterhus, E., & Taba, S. (2004). History of the Medical Home Concept. Pediatrics, 113(5), 1473–1478.

    PubMed  Google Scholar 

  • Squires, D., & Anderson, C. (2015). U.S. health care from a global perspective: Spending, use of services, prices and health in 13 countries. Commonwealth Fund. Pub 1819, Vol. 15, pp. 1–15. Retrieved from https://www.commonwealthfund.org/-/media/files/publications/issue-brief/2015/oct.

  • Starfield, B., Shi, L., & Mackino, J. (2005). Contributions of primary care to health systems and health. The Milbank Quarterly, 83, 457–502.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strosahl, K., & Sobel, D. (1996). Behavioral health and the medical offset cost effect: Current status, key concepts and future applications. HMO Practice, 10, 156–162.

    PubMed  CAS  Google Scholar 

  • Torrence, N. D., Mueller, A. E., Ilem, A. A., Renn, B. N., DeSantis, B., & Segal, D. L. (2014). Medical provider attitudes about behavioral health consultants in integrated primary care: A preliminary study. Families, Systems and Health, 32, 426–432.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cherokee Health Systems, 2018 Western Avenue, Knoxville, TN, 37921, USA

    Dennis S. Freeman, Jeff Howard & Joel Hornberger

  2. Arizona State University, Phoenix, AZ, USA

    Lesley Manson

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  1. Dennis S. Freeman
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Correspondence to Dennis S. Freeman.

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Dennis S. Freeman, Lesley Manson, Jeff Howard, and Joel Hornberger declare that they have no conflict of interest.

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No humans or animal studies were carried out by the authors for this article.

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Freeman, D.S., Manson, L., Howard, J. et al. Financing the Primary Care Behavioral Health Model. J Clin Psychol Med Settings 25, 197–209 (2018). https://doi.org/10.1007/s10880-017-9529-4

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