How Effective is Primary and Behavioral Health Care Integration?

The RAND Corporation, which was commissioned by SAMHSA to evaluate the success of its Primary and Behavioral Health Care Integration (PBHCI) grantees in integrating services and improving consumer health, recently released a report on its findings. This report, entitled “Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program,” provides a detailed catalogue of integration lessons learned that can inform providers and stakeholders looking to integrate services across sectors.

Over the course of its three-year evaluation, the RAND team looked at three main questions to determine the effectiveness of PBHCI programs:

1.      To what extent were programs able to integrate primary and behavioral care services, and how did this influence access to care?

2.      Did the use of integrated services improve consumers’ health outcomes?

3.      What program features were associated with improvements in access to integrated services?

RAND’s results showed considerable variation in the extent to which programs succeeded in integrating primary care and behavioral health care services. On average, programs were quite successful in co-locating services and in creating shared structures and systems, while they struggled most with creating an integrated practice culture. Common barriers to integration that were reported by many programs included the challenge of creating integrated health records; long-term financial sustainability, particularly for non-billable services (such as wellness programs); recruiting and retaining qualified staff; and engaging consumers in integrated services over time.

Related to improvement in health outcomes, consumers treated at PBHCI grantee-operated clinics experienced significant improvement in indicators related to diabetes, dyslipidemia (cholesterol), and hypertension; however, there were no improvements documented for consumers in indicators related to obesity and smoking.

Particular program features that were associated with improved consumer access to services included co-location of services at one site, greater integration of provider practices, and increased staff perceptions of belonging to a team. In addition, consumers demonstrated having greater access to care when served by PBHCI programs that offered more days per week of primary care, as well as those that held more regularly scheduled meetings between integrated staff teams.

To view the full RAND report online, visit Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program: Final Report.