Table 1.

Ingredients for VBID Readiness of Mental Health Services for PTSD.

VBID Ingredients	VBID Readiness for PTSD Treatments and Services
Valid approaches to identify patients	Yes. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)35 and The PTSD Checklist for DSM-5 (PCL-5)36
Valid measures of improvement that can be used as part of measurement-based care	Yes. PCL-537
Outcome-focused quality measures that take the form of assessing the fraction of a given group of patients whose outcomes meet or exceed certain specified clinical objectives	Partially. Quality measures developed for use in the military health system, though not routinely used.38,39
Evidence-based interventions that can be delivered in practice settings	Yes for individual treatments. Individual treatments like Written Exposure Therapy (WET), Prolonged Exposure, and Cognitive Processing Therapy are examples well supported by clinical trials and recommended in clinical practice guidelines.40,41
	Yes for delivery models. Service delivery models like The Collaborative Care Model (CoCM), a specific and evidence-based service delivery model for primary care associated with improved outcomes, improved organization of care, and reduction disparity reduction, is well supported by clinical trials evidence and is recommended in a clinical practice guideline.40–44
Intervention alternatives (either individual treatments or service delivery models) that are being delivered in practice, lack evidence of effectiveness (because they are ineffective or have not been rigorously tested), but could be offered with increased cost sharing	Yes for individual treatments. Individual treatment examples that lack robust evidence include Emotional Freedom Techniques (EFT), Prolonged Exposure in Primary Care (PE-PC), and Seeking Safety (SS)41,45 Yes for service delivery models. Service delivery models with insufficient evidence include Primary Care Behavioral Health (PCBH)46
Evidence of cost-effectiveness	Yes for individual treatments. There is evidence that many evidence based treatments are cost effective and/or can be delivered efficiently.47–49
	Yes for service delivery models. CoCM in general is cost-effective and, in some cases, cost savings.50 Evidence that CoCM for PTSD is cost-effective is positive but lest robust.51–53.
Systematic documentation that the evidence-based intervention was delivered (versus another intervention)	No for individual psychotherapies. There is no standard way to document that one specific psychotherapy was delivered versus another (e.g., WET, which is effective, versus EFT that has insufficient evidence). Billing codes (e.g., CPT codes) can document the delivery of psychotherapy in general but are not psychotherapy specific and are not designed to encourage an indicated dose of psychotherapy.
	Partially for service delivery models. CoCM can specifically be documented via billing code (versus generic care integration codes) in those plans that reimburse for CoCM. However, billing codes may not be a good indicator of intervention fidelity.
Evidence that the interventions promote health equity and/or are associated with reductions of health disparities	Service delivery interventions like CoCM are associated with reductions of health disparities.44 Evidence suggests WET is effective in diverse (to include Spanish speaking) populations.54