Table 3.
Practice Characteristics and Organizing Constructs
| Practice ID | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
|---|---|---|---|---|---|---|---|---|---|
| Practice characteristics, PC/MH/Both | Both | Both | Both | PC | PC | PC | PC | PC | PC |
| Ownership | Private, not for profit | Private, not for profit | Private | Private, not for profit | Hospital system | Private, not for profit | Clinician | Private, not for profit | Clinician |
| Setting | Urban | Suburban | Urban | Suburban | Urban | Suburban | Suburban | Urban | Rural |
| Financial characteristics | |||||||||
| Govt/FQHC/CMHC & FQHC/None | FQHC/CMHC | FQHC/CMHC | Government | FQHC | None | FQHC | None | FQHC | None |
| Practice revenue, % | |||||||||
| Medicare | 7 | 10 | 8 | 7 | 15 | 41 | 24 | 4 | 6 |
| Medicaid | 35 | 38 | 22 | 30 | 26 | 43 | 10 | 49 | 5 |
| Commercial insurance | 39 | 8.2 | 24 | 7 | 59 | 1 | 62 | 11 | 69 |
| Uninsured | 19 | 43.8 | 46 | 56 | 0 | 14 | 4 | 36 | 20 |
| FTE primary care clinicians, n | 37 (22.5) | 8 (6.5) | 56 (48.2) | 11 (11) | 7 (5.8) | 2 (1.2) | 14 (10) | 12 (9.9) | 2 (2) |
| FTE behavioral health clinicians, n | 8 (7.4) | 4 (3.2) | 18 (17.4) | 2 (2) | 2 (1.6) | 4 (3.8) | 2 (0.5)* | 4 (2.9) | 1 (0.5)* |
| Annual patient visits, n | 90,480 | 10,972 | 104,520 | 14,924 | 10,400 | 10,693 | 31,720 | 102,960 | 4,680 |
| BHC can document in EHR? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Characteristics of the integration model | |||||||||
| Breadth and depth of integration reach | |||||||||
| Identification of problem | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening | Systematic Screening |
| Provision of services | Limited | Broad | Broad | Broad | Broad | Limited | Limited | Limited | Limited |
| Relevant workforce located in practice | |||||||||
| Embedded BHC on primary care team | No | Yes | Yes | Yes | Yes | Yes | No | Yes | No |
| Consulting psychiatrist in practice | Yes | Yes | Yes | No | Yes | Yes | No | Yes | No |
| Approach to transitioning patients to BHC | |||||||||
| Warm hand-off | X | X | X | X | |||||
| Referral | X | X | X | X | X | X | |||
| Path identified for other services | |||||||||
| Specialty MH | Referral | Referral | Referred | Referral | Referral | Referral | Referral | Referral | No Path |
| Substance use | Referral | Warm-hand off and referral | Referral | Referral | Referral | Referral | Referral | Referral | Limited |
| Shared mental model for integration | No | Yes | Yes | Yes | Yes | Yes | No | No | No |
| PC | PC | PC | PC | PC | Both | ||||
| PC | MH | MH | MH | ||||||
| 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 |
| Clinician | Hospital system | Hospital system | Clinician | Hospital system, HMO, not for profit | Government | Hospital system | Private, not for profit | Private, not for profit | Private, not for profit |
| Suburban | Rural | Suburban | Urban | Suburban | Urban | Suburban | Rural | Suburban | Rural |
| None | None | FQHC | None | None | Government | FQHC | CMHC | CMHC | CMHC |
| 4 | 5 | 57 | 13.45 | 27 | 54 | 9 | 10 | 0.5 | 3 |
| 0 | 40 | 10 | 3.97 | 0.2 | 0.21 | 48 | 25 | 58 | 40 |
| 91 | 30 | 2 | 63.61 | 72.8 | 14.79 | 8 | 35 | 1.2 | 29 |
| 5 | 25 | 31 | 18.97 | 0 | 31 | 35 | 30 | 14 | 28 |
| 6 (4.8) | 5 (5.0) | 5 (3.15) | 22 (13.6) | 33 (21.9) | 71 (70) | 9 (9) | 6 (6) | 1 (0.4)* | 3 (2.2) |
| 1 (0.5)* | 1 (1.0) | 4 (0.9) | 5 (1.0)† | 1 (0.6) | 6 (5.6) | 2 (1.4) | 2 (2) | 26 (22.8) | 10 (7.9) |
| 15,600 | 27,000 | 8,372 | 47,476 | 27,748 | 159,096 | 17,680 | 31,200 | 4,732 | 7,904 |
| Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | No |
| Systematic Screening | Clinician Discretion | Clinician Discretion | Clinician Discretion | Clinician Discretion | Clinician Discretion | Systematic Screening | Systematic Screening | Clinician Discretion | Systematic screening |
| Limited | Limited | Limited | Limited | Limited | Limited | Limited | Limited | Limited | Limited |
| Yes | No | Yes | Yes | No | Yes | Yes | No | No | Yes |
| No | No | No | No | In system | In system | In system | In system | yes | Yes |
| X | X | X | |||||||
| X | X | X | X | X | X | X | X | ||
| Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral |
| Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral | Referral |
| No | Yes | No | No | Yes | No | No | Yes | Yes | No |
BHC, behavioral health clinician; CMHC, community mental health center, EHR, electronic health record; FTE, full-time equivalent; HMO, health maintenance organization; MH, mental health. PC, primary care.
The designation of government for ownership or financial characteristics indicated a non-FQHC- or CMHC-funded health system where the majority of financing or ownership is from the U.S. government.
*
Due to ebbs and flows in staffing as a result of turnover and the fact that one BHC sometimes provided services to multiple practices, these are estimated FTEs.
†
These 5 BHCs were employees of a BHO and not the primary care practice. The practice contracted with the BHO, and different BHCs rotated hours in the primary care practice.