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Medical Cost Savings After One Year of Integrated Behavioral Health Services in a Rural Pediatric Primary Care Clinic


Andrew Roger Cook

University of Michigan, US
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Introduction: Behavioral health problems are pervasive in primary care and can impede efficient delivery of medical care.  Primary care pediatricians PCPs address behavioral health issues during roughly 1 in 3 visits 1, and these visit require an average of twice as much time than those with only medical concerns 2. Integrated behavioral health IBH in primary care continues to gain empirical support as a collaborative care model for improving patient access, clinical outcomes, and quality of care relative to traditional outpatient services. The present study examined how IBH impacted medical visit costs after its first year of implementation.

Methods: Sample. All patients who presented for an initial behavioral health visit in Michigan Medicine’s first integrated pediatric primary care clinic between August 2013 and August 2014 were included in the sample N= 134.

Independent variable: The independent variable was initiation of IBH treatment. For each patient, data were collected from primary care medical visits in the 12 months before initiating IBH treatment and compared with data 12 months after.

Number of visits: Total number of primary care visits, either sick or well.

Cost: Insurance payments for services made by third-party payers. Costs were adjusted for inflation to year 2014 US Dollars USD using the consumer price index.

Results: Patients in the sample averaged 3.11 primary care medical visits before initial IBH treatment and 2.96 visits afterward. The mean per patient cost of primary care medical treatment was $326 per patient in the year prior to initiating IBH treatment and $254 in the year following.

Discussions: Primary care medical visits were an average of $19.80 less expensive for patients after they initiated IBH services. This resulted in an average cost savings of $71.90 per patient based on the 134 patients who received services in the 1-year period.

Conclusions: Cost savings for medical visits were discovered for patients after initiating behavioral health services in an integrated primary care clinic after only 1 year.   

Lessons learned: IBH services are not only associated with better patient access and outcomes, these services may also reduce cost associated with subsequent medical care. 

Limitations: Cost was determined by reimbursement by insurance companies in this study and may not be applicable for other economic valuations. 

Suggestions for future research: Research analyzing the actual time pediatricians spend treating behavioral health concerns and how this impacts workflow would provide more information on impact on clinical outcomes. 

How to Cite: Cook AR. Medical Cost Savings After One Year of Integrated Behavioral Health Services in a Rural Pediatric Primary Care Clinic. International Journal of Integrated Care. 2018;18(s2):158. DOI:
Published on 23 Oct 2018.


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