Virtual Behavioral Health Integration

Study Overview
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Brief Summary
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The primary objective is to evaluate the effectiveness of the virtual behavioral health integration (VBHI) program compared to usual care, on reducing the total cost of care reimbursed from Medicare and value-based contracts within 90 days of a patient's primary care visit.

Detailed Description
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To enhance the care of patients seen in the primary care setting, Atrium Health has designed a virtual behavioral health integration program. A behavioral health care team comprised of licensed clinicians (Behavioral Health Professionals), health coaches, a consulting psychiatric pharmacist and psychiatric providers follow patients for up to 3 months or more depending on patient need after their primary care office visit. This virtual behavioral health integration (VBHI) program is currently available in 36 Atrium Health primary care practices providing support to over 200 providers and medical residents. The Behavioral health Service line is expanding the program to additional primary care practices. Atrium Health and the Carolinas Physician Alliance is interested in evaluating the effectiveness of the program on reducing the total cost of care.

Official Title
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An Evaluation of Virtual Behavioral Health Integration Into Primary Care

Conditions
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Depression, Substance Use Disorder, Anxiety

Intervention / Treatment
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* Behavioral: Virtual Behavioral Health Integration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older Primary care office visit Have a Patient Health Questionnaire-9 (PHQ-9) and overall score >=10 or Question 9 >0 Medicare or value-based contract associated with a patient in the past year at the time of the primary care visit. Exclusion Criteria: A patient will contribute to the analysis once using their initial enrollment to either arm of the study. No insurance claim for the index primary care visit in the data warehouse upon evaluation.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Locations offering the program are randomized
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual Behavioral Health Integration<br>All patients who meet eligibility criteria at sites where the virtual behavioral health program is offered will be considered exposed to the intervention. | Behavioral: Virtual Behavioral Health Integration<br>* The virtual behavioral health integration program, implemented in primary care settings, is a structured mental illness treatment program that includes both behavioral treatment and counseling components aimed at reducing cost of care, developing and sustaining adaptive coping strategies, and improving short term acute care utilization.<br>|
| No Intervention: Usual Care - Behavioral Health<br>All patients who meet eligibility criteria at sites where the virtual behavioral health program is not offered will be considered exposed to usual care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost of Care | Total cost of care reimbursed from Medicare and value-based contracts | 90 days from a patient's primary care visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare the 90-day acute care utilization rate after the index primary care visit | Does a patient have an inpatient, observation, or emergency department encounter after their primary care visit | 90 days from a patient's primary care visit | 
| Compare the 90-day primary care utilization rate after the index primary care visit | Does a patient have a primary care encounter after their primary care visit | 90 days from a patient's primary care visit | 
| pharmacy Cost of Care | Pharmacy related cost of care reimbursed from Medicare and value-based contracts | 90 days from a patient's primary care visit |