Table 1.
Health plan financing policies that facilitate a continuum of behavioral health (BH) and general medical care integration practices, 2010
| Contracting Arrangements | ||||||||
|---|---|---|---|---|---|---|---|---|
| Total | Specialty External | Hybrid Internal | Internal | |||||
| % | SE | % | SE | % | SE | % | SE | |
| N | 8,427 | 1,219 | 5,899 | 1,278 | ||||
| Reimbursement policies supporting delivery of BH services within primary care | ||||||||
| Talking to patients by phone or email for issues specific to BH | ||||||||
| Yes | 21.7 | 1.6 | 11.8 | 6.5 | 25.7 c | 1.2 | 7.4 c | 5.2 |
| No | 49.8 | 2.0 | 48.6 | 9.4 | 41.4 | 2.1 | 92.2 | 5.2 |
| Don’t know | 28.6 | 1.4 | 39.6 b | 9.9 | 33.0 c | 1.7 | 0.4 b,c | 0.3 |
| Case managers to address BH issues in primary care | ||||||||
| Yes | 36.7 | 1.8 | 3.1 a,b | 2.3 | 47.3 a,c | 1.2 | 16.0 b,c | 3.3 |
| No | 63.1 | 1.8 | 94.8 | 3.4 | 52.7 | 1.2 | 84.0 | 3.3 |
| Don’t know | 0.3 | 0.3 | 2.1 | 2.1 | 0.0 | 0.0 | 0.0 | 0.0 |
| Consultation between primary care provider/staff & BH provider to support BH services in primary care | ||||||||
| Yes | 8.8 | 1.4 | 18.9 a | 4.0 | 4.0 a,c | 0.9 | 23.7 c | 5.9 |
| No | 90.9 | 1.4 | 79.0 | 4.5 | 96.0 | 0.9 | 76.4 | 5.9 |
| Don’t know | 0.3 | 0.3 | 2.1 | 2.1 | 0.0 | 0.0 | 0.0 | 0.0 |
| Provide financial incentives to primary care providers focused on treatment of | ||||||||
| Depression | ||||||||
| Yes | 18.3 | 1.2 | 0.3 a,b | 0.2 | 24.9 a,c | 1.2 | 5.5 b,c | 1.5 |
| No | 77.2 | 1.4 | 74.9 | 6.8 | 75.1 | 1.2 | 88.5 | 4.9 |
| Don’t know | 4.5 | 1.6 | 24.8 a,b | 6.8 | 0.0 a | 0.0 | 6.1 b | 5.1 |
| Substance use disorders* | ||||||||
| Yes | 17.7 | 1.2 | 0.0 b | 0.0 | 24.9 c | 1.2 | 1.5 b,c | 1.0 |
| No | 77.8 | 1.4 | 75.2 | 6.8 | 75.1 | 1.2 | 92.4 | 5.1 |
| Don’t know | 4.5 | 1.6 | 24.8 a,b | 6.8 | 0.0 a | 0.0 | 6.1 b | 5.1 |
| Reimbursement policies supporting coordination between primary and specialty BH care | ||||||||
| Increased reimbursed for care delivered in integrated settings of BH with medical care (e.g. medical home) | ||||||||
| Yes | 34.5 | 1.5 | 22.7 | 7.6 | 39.9 c | 1.5 | 13.3 c | 2.9 |
| No | 62.4 | 1.6 | 42.3 | 9.2 | 60.1 | 1.5 | 85.9 | 3.0 |
| Don’t know | 3.1 | 1.0 | 35.0 a,b | 9.7 | 0.0 a | 0.0 | 0.9 b | 0.5 |
| Services delivered by BH provider co-located in medical practice | ||||||||
| Yes | 66.0 | 2.1 | 30.0 a,b | 5.3 | 67.1 a,c | 1.7 | 96.4 b,c | 1.5 |
| No | 33.8 | 2.1 | 67.9 | 5.6 | 33.0 | 1.7 | 3.6 | 1.5 |
| Don’t know | 0.3 | 0.3 | 2.1 | 2.1 | 0.0 | 0.0 | 0.0 | 0 |
| BH therapy and medical evaluation & management codes billed on same day | ||||||||
| Yes | 89.1 | 2.0 | 36.2 a,b | 5.7 | 98.5 a | 0.4 | 94.2 b | 2.0 |
| No | 10.6 | 2.0 | 61.7 | 6.0 | 1.5 | 0.4 | 5.8 | 2.0 |
| Don’t know | 0.3 | 0.3 | 2.1 | 2.1 | 0.0 | 0.0 | 0.0 | 0.0 |
| Composite measure of queried financing policies to support integration (0 to 6)** | ||||||||
| 0 | 1.3 | 0.5 | 16.4 a,b | 6.6 | 0.0 a,c | 0.0 | 0.8 b,c | 0.4 |
| 1 | 24.3 | 1.7 | 12.7 b | 3.0 | 17.3 c | 1.0 | 63.3 b,c | 5.8 |
| 2 | 46.5 | 1.5 | 40.4 b | 10.7 | 53.5 c | 1.2 | 14.8 b,c | 2.2 |
| 3 | 27.0 | 1.6 | 29.4 | 9.1 | 29.2 c | 1.6 | 15.8 c | 5.5 |
| 4 or more | 0.9 | 0.2 | 1.2 b | 1.4 | 0.0 c | 0.0 | 5.2 b,c | 1.5 |
N represents weighted total number of products
Pairs that share a superscript letter within row are significantly different (P<0.05); “No” responses not tested.
Asked separately for alcohol dependence and drug use disorders; responses were identical
Index variable of the following reimbursement policies: (1) taking to patients by phone or email, (2) case manager, (3) consultation, (4) any financial incentives, (5) care in integrated settings, and (6) care in co-located settings
Percentages are based on reported data with missing data excluded. Missing data are less than 3% except for talking to patients by phone or email (8%) and increased reimbursement for care delivered in integrated settings (9%)