Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices
Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices
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DOI：
10.1007/s11606-017-4177-9
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发表时间：
2017-12-01
影响因子：
5.7
通讯作者：
Phillips, Russell S.
中科院分区：
文献类型：
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作者：
Basu, Sanjay;Landon, Bruce E.;Phillips, Russell S.
为了评估整合行为健康服务对初级保健实践的财务影响，我们模拟了联邦合格卫生中心（CDHCs）的患者和提供者，城市和农村高贫困地区的非CDHCs，全国社区卫生中心协会、全国门诊医疗调查、全国健康和营养检查调查，一种协作护理模式（CoCM），包括来自行为主义护理管理者的基于电话的随访，或初级护理行为主义模式（PCBM），涉及诊所内行为学家。每名全职医生的净收入变化。当行为健康整合服务仅提供给医疗保险患者时，CoCM下的净收入（第1年平均每MD 25，026美元，随后几年为28，548美元/年）高于PCBM（第1年为-7052美元，随后几年为-3706美元/年）。当行为健康整合服务提供给所有患者，并由医疗保险和私人支付者报销时，只有采用CoCM方法的实践始终获得净收入。该模型的结果是敏感的患者转诊接受率，介绍，治疗完成，但CoCM的方法仍然是一贯的财政可行性，而PCBM不会在长期跨实践types.New医疗保险支付可能会提供初级保健实践整合行为健康服务的财政可行性，但这种可行性取决于对护理整合的方法。
New payments from Medicare encourage behavioral health services to be integrated into primary care practice activities.To evaluate the financial impact for primary care practices of integrating behavioral health services.Microsimulation model.We simulated patients and providers at federally qualified health centers (FQHCs), non-FQHCs in urban and rural high-poverty areas, and practices outside of high-poverty areas surveyed by the National Association of Community Health Centers, National Ambulatory Medical Care Survey, National Health and Nutrition Examination Survey, and National Health Interview Survey.A collaborative care model (CoCM), involving telephone-based follow-up from a behaviorist care manager, or a primary care behaviorist model (PCBM), involving an in-clinic behaviorist.Net revenue change per full-time physician.When behavioral health integration services were offered only to Medicare patients, net revenue was higher under CoCM (averaging $25,026 per MD in year 1 and $28,548/year in subsequent years) than PCBM (-$7052 in year 1 and -$3706/year in subsequent years). When behavioral health integration services were offered to all patients and were reimbursed by Medicare and private payers, only practices adopting the CoCM approach consistently gained net revenues. The outcomes of the model were sensitive to rates of patient referral acceptance, presentation, and therapy completion, but the CoCM approach remained consistently financially viable whereas PCBM would not be in the long-run across practice types.New Medicare payments may offer financial viability for primary care practices to integrate behavioral health services, but this viability depends on the approach toward care integration.