Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, CO, USA.
Psychology Department, University of Colorado Denver, Denver, CO, USA.
Transl Behav Med. 2019 Mar 1;9(2):274-281. doi: 10.1093/tbm/iby054.
Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).
在初级保健环境中为行为健康服务提供资金支持和维持其运转仍然是广泛实施的主要障碍。“通过综合初级保健努力维持医疗保健（SHAPE）”是一个示范项目，旨在前瞻性地研究利用替代支付方法为具有综合行为健康服务的初级保健实践提供行为健康服务所带来的成本节约。科罗拉多州的六家初级保健诊所参与了该项目。每家诊所都至少有一名现场行为健康临床医生提供综合行为健康服务。其中三家诊所获得了非按服务收费的付款（即 SHAPE 付款），以支持在 18 个月内提供行为健康服务。另外三家诊所没有收到 SHAPE 付款，作为对照实践进行比较。条件分配是非随机的。在 SHAPE 示范项目开始前的 9 个月（预期间）和 SHAPE 项目期间的 18 个月（后期间）收集了患者的索赔数据，以评估成本节约。在后期间的 18 个月中，对实践索赔数据的分析表明，接受 SHAPE 付款的实践为其公共支付者人群（即 Medicare、Medicaid 和双重资格；N=9042）节省了约 108 万美元的净成本。节省的成本主要是通过减少下游利用（例如住院治疗）实现的。SHAPE 示范项目发现，将行为健康纳入初级保健的非按服务收费支付可能与公共支付者的显著成本节约相关，这可能对公共项目（例如 Medicaid）的未来交付和支付工作产生影响。
