The Relationship Between Integrated Pediatric Psychology and Primary Care Visit Length, Revenue, Content Over 24 Months

• Published in: Families systems & health 2020-09, Vol.38 (3), p.278-286
• Main Authors: Gormley, Matthew J, Meadows, Tawnya J, Hostermans, Shelley J, Kettlewell, Paul W, Kirchner, H. Lester, O'Dell, Sean M
• Format: Article
• Language: English
• Subjects: Behavioral psychology; Care and treatment; Child psychiatric services; Child psychology; Child psychopathology; Childhood Development; Childhood mental disorders; Economic aspects; Health care expenditures; Health Care Psychology; Health care teams; Health Personnel; Health visiting; Human; Integrated Services; Methods; Pediatrics; Primary care; Primary Health Care
• ISSN: 1091-7527; 1939-0602
• DOI: 10.1037/fsh0000532

Introduction: Integrating behavioral health providers into pediatric primary care to provide behavioral health (BH) services is both effective and efficient; however, the impact of pediatric integrated services on the operational and financial outcomes of primary care provider (PCP) visits has not been thoroughly investigated. The present study examined whether length of practice integration predicts the relationship between BH content addressed in a PCP visit, visit length, and revenue generation. Method: A total of 1,209 pediatric encounters with 25 PCPs across 7 primary care offices in a predominantly rural health system were abstracted for the presence or absence of BH content, visit length, duration of integration, and revenue. χ2 analyses and the generalized linear model framework were used to address the study objectives. Results: Integration was associated with more PCP visits with a BH topic discussed at 6-11 months of integration but not at 14-24 months. Visits with a BH topic were longer than medical-only visits and shorter when a practice was integrated for 6-11 months but not at 14-24 months of integration. Public insurance and integration were associated with lower revenue generation per minute. Visit content was not associated with PCP revenue. Discussion: Results suggest a relationship between integration and the operational and financial outcomes of PCP visits. This study shows that initial efficiencies or improvements (e.g., time, cost, content) associated with integrating BH may be lost over time. Future studies should evaluate sustainability in relation to program impact. Public Significance Statement This study evaluated the impact of integrated services on the operational and financial outcomes of primary care provider (PCP) visits. Using actual revenue generation (versus negotiated rates), we found a relationship between integration and operational and financial outcomes of these visits; however, initial efficiencies or improvements may be lost over time. Results indicate a need for prospective studies to further evaluate the operational, clinical, and financial variables related to integrated care.