Behavioral Health Integration Model
William Douglas Tynan, Ph.D.
Office of Integrated Health Care , American Psychological Association, Washington, DC, USA.
J Gen Intern Med
© Society of General Internal Medicine 2018
BEHAVIORAL HEALTH INTEGRATION MODEL
Basu et al. developed sophisticated models of costs and reve-
nue to evaluate the fiscal viability of two behavioral health
integration models—the Collaborative Care Model (CoCM)
and Primary Care Behavioral Health (PCBH).
that the CoCM model will take less staff time per patient and
will generate more revenue.
The fiscal data flows from the models presented but an
examination of the two models described raises serious
The authors define the first model (CoCM) as a nurse care
manager providing telephonic care management only, with 1
hour per week of psychiatry time to supervise an active case-
load of 120 patients with depression. No face-to-face time with
a mental health provider is included in this model.
This definition does not match the CoCM model studied
and described in the literature. Recommended staffing for
psychiatric providers with an active panel of 120 patients is
4 hours per week, along with two or three care managers who
provide face-to-face service and telephone contact.
more than 80 RCT studies of CoCM, none have used tele-
phone contact only. Moreover, the time per patient calcula-
tions do not reflect the research cited by the authors. Basu et al.
state that their telephone sessions are 35 minutes while the
study they referenced indicates 51–60minutes on average.
The second model, PCBH, includes a licensed mental
health professional who bills for mental health services pro-
vided while embedded within the primary care clinic team.
Basu et al. define behavioral treatment as eight 45-minute
A recent review of evidence-based therapies deliv-
ered in primary care indicates effective treatment in 3–6ses-
Thus, the course of therapy and total time for therapy in
PCBH is shorter, not longer, than what would be done in the
The two models as described do not accurately reflect
existing models in terms of staffing, mode of services, and
time per patient. All the cost data results from those assump-
tions and so are questionably valid. The independent variable,
the two types of integrated care, do not align to CoCM or
PCBH models described in the literature.
The basic models
and independent variables to be compared are flawed, hence
accurate financial conclusions cannot be reached.
In addition, as health care moves away from fee for service
billing to payment for quality and outcome, the impact of
improved clinical outcome has an impact on payment. Fiscal
modeling therefore must include variables such as reductions
in emergency visits and rehospitalizations. A model simply
focused on reducing costs and increasing fee for service is not
Corresponding Author: William Douglas Tynan, Ph.D.; Office of
Integrated Health Care American Psychological Association, Wash-
ington, DC, USA (e-mail: email@example.com).
Compliance with ethical standards:
Conflict of interest: The authors declare that they do not have a
conflict of interest.
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