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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Behavioral Health and the Comprehensive Primary Care (CPC) Initiative: findings from the 2014 CPC behavioral health survey

Authors: Kara Zivin, Benjamin F. Miller, Bruce Finke, Asaf Bitton, Perry Payne, Edith C. Stowe, Ashok Reddy, Timothy J. Day, Pauline Lapin, Janel L. Jin, Laura L. Sessums

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Incorporating behavioral health care into patient centered medical homes is critical for improving patient health and care quality while reducing costs. Despite documented effectiveness of behavioral health integration (BHI) in primary care settings, implementation is limited outside of large health systems. We conducted a survey of BHI in primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a four-year multi-payer initiative of the Centers for Medicare and Medicaid Services (CMS). We sought to explore associations between practice characteristics and the extent of BHI to illuminate possible factors influencing successful implementation.

Method

We fielded a survey that addressed six substantive domains (integrated space, training, access, communication and coordination, treatment planning, and available resources) and five behavioral health conditions (depression, anxiety, pain, alcohol use disorder, and cognitive function). Descriptive statistics compared BHI survey respondents to all CPC practices, documented the availability of behavioral health providers, and primary care and behavioral health provider communication. Bivariate relationships compared provider and practice characteristics and domain scores.

Results

One hundred sixty-one of 188 eligible primary care practices completed the survey (86% response rate). Scores indicated basic to good baseline implementation of BHI in all domains, with lowest scores on communication and coordination and highest scores for depression. Higher scores were associated with: having any behavioral health provider, multispecialty practice, patient-centered medical home designation, and having any communication between behavioral health and primary care providers.

Conclusions

This study provides useful data on opportunities and challenges of scaling BHI integration linked to primary care transformation. Payment reform models such as CPC can assist in BHI promotion and development.
Appendix
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Literature
1.
American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), (AOA) AOA: Joint Principles of the Patient-Centered Medical Home. 2007.
2.
Ferrante JM, Balasubramanian BA, Hudson SV, Crabtree BF. Principles of the patient-centered medical home and preventive services delivery. Annals of Family Medicine. 2010;8(2):108–16.CrossRefPubMedPubMedCentral
3.
Peikes D, Zutshi A, Genevro J, Smith K, Parchman M, Meyers D. Early Evidence on the Patient-Centered Medical Home. Final Report. In. Rockville, MD: Agency for Healthcare Research and Quality; 2012.
4.
Stanek M, Takach M: Evaluating the patient-centered medical home: potential and limitations of claims-based data. In: Briefing. National Academy for State Health Policy; 2010.
5.
Starfield B, Shi L. The medical home, access to care, and insurance: a review of evidence. Pediatrics. 2004;113(5 Supplement):1493–8.PubMed
6.
Klein S, Hostetter M: In Focus: Integrating Behavioral Health and Primary Care. In: The Commonwealth Fund. 2014.
7.
Massa I, Miller BF, Kessler R. Collaboration between NCQA Patient-Centered Medical Homes and specialty behavioral health and medical services. Translational Behavioral Medicine. 2012;2(3):332–6.CrossRefPubMedPubMedCentral
8.
Petterson S, Miller BF, Payne-Murphy JC, Phillips RL. Mental health treatment in the primary care setting: patterns and pathways. Families, Systems, and Health. 2014;32(2):157–66.CrossRefPubMed
9.
Unutzer J, Harbin H, Schoenbaum M, Druss B: The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. In: Health Home Information Resource Center. 2013.
10.
Butler M, Kane R, McAlpine DD, Kathol RG, Fu SS, Hagedorn H, Wilt TJ. Evidence report/technology assessment. In: Integration of Mental Health/Substance Abuse and Primary Care. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
11.
Kwan BM, Nease Jr DE: The State of the Evidence for Integrated Behavioral Health in Primary Care. In: Integrated Behavioral Health in Primary Care. edn.: Springer; 2013: 65-98.
12.
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs. 2008;27(3):759–69.CrossRefPubMed
13.
Baird M, Blount A, Brungardt S, Dickinson P, Dietrich A, Epperly T, Green L, Henley D, Kessler R, Korsen N, et al. The development of joint principles: Integrating behavioral health care into the patient-centered medical home. Annals of Family Medicine. 2014;12(2):183–5.CrossRef
14.
Katon WJ, Unutzer J. Health reform and the Affordable Care Act: The importance of mental health treatment to achieving the triple aim. Journal of Psychosomatic Research. 2013;74(6):533–7.CrossRefPubMed
15.
Institute for Healthcare Improvement: IHI 90-Day R&D Project Final Summary Report: Integrating Behavioral Health and Primary Care. In. Cambridge, MA: Institute for Healthcare Improvement; 2014.
16.
DeGruy FV, Etz RS. Attending to the whole person in the patient-centered medical home: the case for incorporating mental healthcare, substance abuse care, and health behavior change. Families, Systems, and Health. 2010;28(4):298–307.CrossRefPubMed
17.
Dickinson WP, Miller BF. Comprehensiveness and continuity of care and the inseparability of mental and behavioral health from the patient-centered medical home. Families, Systems, and Health. 2010;28(4):348–55.CrossRefPubMed
18.
Kessler R, Miller BF, Kelly M, Graham D, Kennedy A, Littenberg B, MacLean CD, van Eeghen C, Scholle SH, Tirodkar M, et al. Mental health, substance abuse, and health behavior services in patient-centered medical homes. J Am Board Fam Med. 2014;27(5):637–44.CrossRefPubMed
19.
Blount A. Integrated Primary Care: Organizing the Evidence. Families, Systems, & Health. 2003;21(2):121.CrossRef
20.
Cohen DJ, Balasubramanian BA, Davis M, Hall J, Gunn R, Stange KC, Green LA, Miller WL, Crabtree BF, England MJ et al: Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices. J Am Board Fam Med. 2015, 28(Supplement 1):S7-S20.
21.
Cohen DJ, Davis MD, Balasubramanian BA, Gunn R, Hall J, de Gruy FV, Peek CJ, Green LA, Stange KC, Pallares C et al: The Dance of Collaboration: Consulting, Coordinating, and Collaborating Journal of the American Board of Family Medicine 2015.
22.
Davis M, Balasubramanian BA, Waller E, Miller BF, Green LA, Cohen DJ. Integrating behavioral and physical health care in the real world: early lessons from advancing care together. J Am Board Fam Med. 2013;26(5):588–602.CrossRefPubMed
23.
Peek C. National Integration Academy Council: Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. In. Rockville, MD: Agency for Healthcare Research and Quality; 2013.
24.
Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. 2004;291(10):1246–51.CrossRefPubMed
25.
Gallo JJ, Bogner HR, Morales KH, Post EP, Ten Have T, Bruce ML. Depression, cardiovascular disease, diabetes, and two-year mortality among older, primary-care patients. Am J of Geriatr Psychiatry. 2005;13(9):748–55.CrossRef
26.
Jortberg BT, Miller BF, Gabbay RA, Sparling K, Dickinson WP. Patient-centered medical home: how it affects psychosocial outcomes for diabetes. Curr Diab Rep. 2012;12(6):721–8.CrossRefPubMed
27.
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database of Sys Rev. 2012;10:CD006525.
28.
Department of Veterans Affairs Veterans Health Administration: Uniform mental health services in VA medical centers and clinics. In: VHA Handbook 116001. 2008: 43.
29.
Miller BF, Petterson S, Brown Levey SM, Payne-Murphy JC, Moore M, Bazemore A. Primary care, behavioral health, provider colocation, and rurality. J Am Board Fam Med. 2014;27(3):367–74.CrossRefPubMed
30.
Kathol RG, Butler M, McAlpine DD, Kane RL. Barriers to Physical and Mental Condition Integrated Service Delivery. Psychosomatic Medicine. 2010;72(6):511–8.CrossRefPubMed
31.
Zivin K, Katon W. Further policy changes are needed to improve depression care. Gen Hosp Psychiatry. 2015;37(4):368–9.CrossRefPubMed
32.
Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings. Annals of Internal Medicine. 2014;160(1):61–5.CrossRefPubMed
33.
Press MJ, Howe R, Schoenbaum M, Cavanaugh S, Marshall A, Baldwin L, Conway PH. Medicare Payment for Behavioral Health Integration. N Engl J Med. 2017;376(5):405–7.CrossRefPubMed
34.
Taylor EF, Anglin G, Dales S, Keith R, Peikes D, Shapiro R, Brown R, Ghosh A, Crosson J: Evaluation of the Comprehensive Primary Care Initiative: First Annual Report. In.: Mathematica Policy Research; 2015.
35.
Peikes DN, Reid RJ, Day TJ, Cornwell DD, Dale SB, Baron RJ, Brown RS, Shapiro RJ. Staffing patterns of primary care practices in the comprehensive primary care initiative. Ann Fam Med. 2014;12(2):142–9.CrossRefPubMedPubMedCentral
36.
Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB, Taylor EF, Swankoski K, O'Malley AS, Conway PH, Rajkumar R, et al. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative. N Engl J Med. 2016;374(24):2345–56.CrossRefPubMed
37.
National Center for Quality Assurance: NCQA PCMH 2011 Standards, Elements and Factors. In. Washington, D.C.: National Center for Quality Assurance; 2011.
38.
Daniel DM, Wagner EH, Coleman K, Schaefer JK, Austin BT, Abrams MK, Phillips KE, Sugarman JR. Assessing progress toward becoming a patient-centered medical home: an assessment tool for practice transformation. Health Services Research. 2013;48(6 Part 1):1879–97.CrossRefPubMedPubMedCentral
39.
Bonomi AE, Wagner EH, Glasgow RE, VonKorff M. Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Services Research. 2002;37(3):791–820.CrossRefPubMedPubMedCentral
40.
Peikes D, Swankoski K, Mutti A, Anglin G, Converse L, Grannemann T, Taylor EF, Keith R, Zutshi A, Dale S: Evaluation of the Comprehensive Primary Care Initiative: Third Annual Report. In.: Mathematica Policy Research; 2016.
41.
Peikes D, Taylor E, Dale S: Evaluation of the Comprehensive Primary Care Initiative: second annual report. In., vol. 13: Mathematica Policy Research; 2016.
42.
Burwell SM: Setting Value-Based Payment Goals - HHS Efforts to Improve U.S. Health Care. New England Journal of Medicine 2015.
43.
Edwards ST, Bitton A, Hong J, Landon BE. Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased. Health Affairs. 2014;33(10):1823–31.CrossRefPubMed
44.
Peek CJ, National Integration Academy Council.: Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. In: AHRQ Publication No13-IP001-EF. Edited by Agency for Healthcare Research and Quality; 2013.
Metadata
Title
Behavioral Health and the Comprehensive Primary Care (CPC) Initiative: findings from the 2014 CPC behavioral health survey
Authors
Kara Zivin
Benjamin F. Miller
Bruce Finke
Asaf Bitton
Perry Payne
Edith C. Stowe
Ashok Reddy
Timothy J. Day
Pauline Lapin
Janel L. Jin
Laura L. Sessums
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2562-z

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