Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Gouge, Natasha; Polaha, Jodi; Rogers, Rachel; Harden, Amy
• Is Part Of: Southern medical journal. Volume 109:Issue 12(2016)
• Publication Date: 2016-12
• Subjects: behavioral health -- collaborative practice -- integrated care -- mental health -- pediatric primary care; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000564
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Methods: Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. Results: On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. Conclusions: 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. Abstract : Research has shown that an integrated behavioral health consultant adds value to pediatric primary care services, including better patient outcomes, decreased medical visits, and improved provider satisfaction. This model has been proven cost-effective in large healthcare systems that use bundled payment methods. This study shows that in a small stand-alone pediatric primary care clinic, an integrated behavioral health consultant can save provider time. Providers in this study used the extra time to see more patients and generate more revenue.