A Behavioral Health Integration Framework for Alternative Payment Models

Abstract

<h3>Context:</h3> Behavioral health integration (BHI) in primary care improves outcomes and decreases costs; yet its uptake has been limited by inadequate payment. Payers have expressed a need to understand how additional resources for BHI will be used. Implementation of BHI varies depending on patient population needs, practice resources, and local workforce availability. <h3>Objective:</h3> To develop a framework for BHI in primary care that would inform the design of alternative payment models supporting BHI, align payer expectations, decrease administrative burden on practices, and achieve a level of standardization of BHI care delivery requirements that enhance patient care while still allowing for flexibility. <h3>Study design:</h3> (1) Milestones used for the Colorado State Innovation Model were examined to select items specific to BHI that could be overlaid on more general milestones for advancing primary care. These items were divided into foundation and additional modular components of BHI: advanced coordination and care management, integrated behavioral health professionals, psychiatry, and the advanced care of substance use disorders. (2) Other frameworks for BHI were reviewed to identify any gaps. (3) Key informant interviews were held to obtain feedback from relevant stakeholders to further refine the framework. <h3>Dataset:</h3> Other frameworks and tools reviewed: Colorado State Innovation Model milestones, NCQA BH distinction, Continuum-based framework for integrated care, Integrated Practice Assessment Tool, Practice Integration Profile. <h3>Population studied:</h3> 15 key informant interviews were conducted with payers, policymakers, behavioral health and primary care providers, practice transformation experts, and patient advocates. <h3>Instrument:</h3> A semi-structured, piloted interview guide was used for key informant interviews. <h3>Results:</h3> A refined framework outlining care delivery expectations for varied implementation approaches of BHI, designed to be used by payers and policymakers in developing alternative payment methodologies to support BHI. <h3>Conclusions:</h3> This framework can be applied to alternative payment models at the state, regional, and federal levels to improve alignment of expectations across payers, providers, and patients.