Department of Family Medicine, University of North Carolina at Chapel Hill.
School of Social Work, University of Pittsburgh.
Fam Syst Health. 2023 Dec;41(4):527-536. doi: 10.1037/fsh0000827. Epub 2023 Sep 28.
Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs).
This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes.
Administrators ( = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews ( = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services.
Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
尽管有证据支持将行为健康和身体健康护理相结合，但由于缺乏可靠和可持续的融资机制，综合行为健康（IBH）的采用一直受到阻碍。本研究旨在提供有关在合格的联邦健康中心（FQHC）中使用精神病协作护理模式（CoCM）和行为健康整合（BHI）代码以及实施 IBH 的信息。
这项横断面混合方法研究涉及对管理人员进行电子调查，并对调查受访者的一部分进行后续定性访谈。使用描述性分析对定量数据进行分析，并使用主题编码对定性数据进行分析，以确定突出的主题。
来自 11 个州的 11 位管理员完成了调查。CoCM（13%）或 BHI 代码（17.4%）的使用率较低。大多数管理员不知道 CoCM（72%）或 BHI 代码（70%）的存在。定性访谈（n=9）描述了进一步使 IBH 和代码使用复杂化的障碍，例如劳动力短缺和提供 CoCM 服务的成本报销不足。
尽管 FQHC 正在努力满足其服务社区的需求，但计费不明确和缺乏意识以及劳动力问题阻碍了 CoCM 的采用。FQHC 面临着为保障人群提供护理的诸多需求，但他们没有完全配备提供 CoCM/BHI 计费所需的资源、工作流程、人员配备和支付结构。需要增加财务和后勤支持来建立实践基础设施，以减少当前阻碍 CoCM 和综合护理实施的行政复杂性和不足的报销机制。（PsycInfo 数据库记录（c）2024 APA，保留所有权利）。
