Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Cornerstone Whole Healthcare Organization Inc, Payette, ID, USA.
Transl Behav Med. 2022 Aug 17;12(8):878-883. doi: 10.1093/tbm/ibac053.
Recent value-based payment reforms in the U.S. called for empirical data on how primary care practices of varying characteristics fund their integrated behavioral health services. To describe payment strategies used by U.S. primary care practices to fund behavioral health integration and compare strategies between practices with and without hospital affiliation.Baseline data were used and collected from 44 practices participating in a cluster-randomized, pragmatic trial of behavioral health integration. Data included practice characteristics and payment strategies-fee-for-service payment, pay-for-performance incentives, grants, and graduate medical education funds. Descriptive and comparative analyses using Fisher's exact tests and independent T-tests were conducted. The sample had 26 (59.1%) hospital-affiliated (hospital/health system-owned, academic medical centers and hospital-affiliated practices) and 18 (40.9%) non-hospital-affiliated practices (community health centers/federally qualified health centers and privately-owned practices). Most practices (88.6%) received payments through fee-for-service; 63.6% received pay-for-performance incentives; 31.8% received grant funds. Collaborative Care Management billing (CPT) codes were used in six (13.6%) practices. Over half (53.8%) of hospital-affiliated practices funded their behavioral health services through fee-for-service and pay-for-performance incentives only, as opposed to two-thirds (66.7%) of non-hospital-affiliated practices required additional support from grants and/or general medical education funds. Primary care practices support behavioral health integration through diverse payment strategies. More hospital-affiliated practices compared to non-hospital-affiliated practices funded integrated behavioral health services through fee-for-service and pay-for-performance incentives. Practices without hospital affiliation relied on multiple funding streams including grants and/or general medical education funds, suggesting their approach to financial sustainment may be more precarious or challenging, compared to hospital-affiliated practices.
美国最近的基于价值的支付改革要求提供关于不同特征的初级保健实践如何为其综合行为健康服务提供资金的实证数据。描述美国初级保健实践用于为行为健康整合提供资金的支付策略，并比较具有和不具有医院附属关系的实践之间的策略。使用并从参与行为健康整合的集群随机、实用试验的 44 个实践中收集基线数据。数据包括实践特征和支付策略——按服务收费、按绩效付费激励、赠款和研究生医学教育基金。使用 Fisher 精确检验和独立 T 检验进行描述性和比较性分析。样本中有 26 家（59.1%）与医院有关联（医院/医疗系统所有、学术医疗中心和医院附属实践）和 18 家（40.9%）与医院无关（社区健康中心/联邦合格的健康中心和私人拥有的实践）。大多数实践（88.6%）通过按服务收费获得报酬；63.6%获得按绩效付费激励；31.8%获得赠款。六种（13.6%）实践使用协同护理管理计费（CPT）代码。一半以上（53.8%）的与医院有关联的实践仅通过按服务收费和按绩效付费激励为其行为健康服务提供资金，而三分之二（66.7%）的与医院无关的实践需要通过赠款和/或一般医学教育基金提供额外支持。初级保健实践通过多种支付策略支持行为健康整合。与非医院附属实践相比，更多的医院附属实践通过按服务收费和按绩效付费激励为综合行为健康服务提供资金。没有医院附属关系的实践依赖于多种资金来源，包括赠款和/或一般医学教育基金，这表明与医院附属实践相比，他们的财务维持方式可能更加不稳定或具有挑战性。
