title: Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost.
abstract: Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not.
  
  
  
  Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated.
  
  
  
  On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present.
  
  
  
  The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.
authors.affiliation: From Mountain States Medical Group, Pediatrics, Kingsport, Tennessee, the Department of Family Medicine, East Tennessee State University, Johnson City, and Mountain View Pediatrics, Marion, Virginia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gouge
authors.affiliation: From Mountain States Medical Group, Pediatrics, Kingsport, Tennessee, the Department of Family Medicine, East Tennessee State University, Johnson City, and Mountain View Pediatrics, Marion, Virginia.
authors.forename: Jodi
authors.initials: J
authors.lastname: Polaha
authors.affiliation: From Mountain States Medical Group, Pediatrics, Kingsport, Tennessee, the Department of Family Medicine, East Tennessee State University, Johnson City, and Mountain View Pediatrics, Marion, Virginia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rogers
authors.affiliation: From Mountain States Medical Group, Pediatrics, Kingsport, Tennessee, the Department of Family Medicine, East Tennessee State University, Johnson City, and Mountain View Pediatrics, Marion, Virginia.
authors.forename: Amy
authors.initials: A
authors.lastname: Harden
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D006801:Humans; D010348:Patient Care Team / Q000191:economics* / Q000458:organization & administration; D010372:Pediatrics / Q000191:economics* / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D002666:Psychology, Child / Q000191:economics* / Q000458:organization & administration; D013997:Time Factors