E02 – The Building Blocks of Behavioral Health Integration: A Framework to Align Care Delivery Expectations in Alternative Payment Models

Summary

Background: Implementation of behavioral health integration (BHI) in a practice varies depending on needs of the patient population, practice resources, and local workforce availability. Given this variation, there is no single model that will be the right fit for all practices in how they approach integrating care. Furthermore, practices often implement integration in a hybrid approach that blends elements of different models. Payers have expressed a need to understand what additional resources for BHI are used for and to have demonstrated accountability from practices. Objective: To develop a framework for BHI in primary care to inform the design of alternative payment models supporting BHI, align payer expectations, decrease administrative burden on practices, and achieve a level of standardization of BHI care delivery requirements that enhance patient care while still allowing for flexibility. Study design and procedures: (1) Milestones used for the Colorado State Innovation Model were examined to select items specific to BHI, (2) BHI milestones were refined and categorized into components of implementation approaches, (3) Other frameworks were reviewed to identify any gaps, (4) Key informants were interviewed using a semi-structured format and the framework was further refined based on feedback. Population sampled: 15 key informants were interviewed, including payers, patient advocates, policy experts, behavioral health providers, and primary care providers. Results: A framework was developed outlining foundational care delivery expectations for BHI as well as for additional components: integrated behavioral health professional, advanced coordination and care management, psychiatry, and advanced care of substance use disorders. Conclusion: This framework can be used by payers and policymakers in developing aligned alternative payment model strategies for BHI.