Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States

A. Malâtre-Lansac, C. Engel, L. Xenakis, Lindsey Carlasare, K. Blake, Carol Vargo, Christopher Botts, Peggy G. Chen, M. Friedberg • 6/2/2020

Abstract

BACKGROUND Behavioral health integration is uncommon among U.S. physician practices despite recent policy changes that may encourage its adoption. OBJECTIVE To describe factors influencing physician practices' implementation of behavioral health integration. DESIGN Semistructured interviews with leaders and clinicians from physician practices that adopted behavioral health integration, supplemented by contextual interviews with experts and vendors in behavioral health integration. SETTING 30 physician practices, sampled for diversity on specialty, size, affiliation with parent organizations, geographic location, and behavioral health integration model (collaborative or co-located). PARTICIPANTS 47 physician practice leaders and clinicians, 20 experts, and 5 vendors. MEASUREMENTS Qualitative analysis (cyclical coding) of interview transcripts. RESULTS Four overarching factors affecting physician practices' implementation of behavioral health integration were identified. First, practices' motivations for integrating behavioral health care included expanding access to behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs, and enhancing practice reputation. Second, practices tailored their implementation of behavioral health integration to local resources, financial incentives, and patient populations. Third, barriers to behavioral health integration included cultural differences and incomplete information flow between behavioral and nonbehavioral health clinicians and billing difficulties. Fourth, practices described the advantages and disadvantages of both fee-for-service and alternative payment models, and few reported positive financial returns. LIMITATION The practice sample was not nationally representative and excluded practices that did not implement or sustain behavioral health integration, potentially limiting generalizability. CONCLUSION Practices currently using behavioral health int...

Citations: 17