Cost savings associated with an alternative payment model for integrating behavioral health in primary care

Transl Behav Med. 2019 Mar 1;9(2):274-281. doi: 10.1093/tbm/iby054.


Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

Keywords: Alternative payment models; Behavioral health; Finance; Integrated behavioral health and primary care; Primary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Behavioral Medicine / economics
  • Cost Savings*
  • Delivery of Health Care, Integrated / economics*
  • Delivery of Health Care, Integrated / methods
  • Female
  • Humans
  • Male
  • Medicaid / economics
  • Medicare / economics
  • Middle Aged
  • Primary Health Care / economics*
  • Primary Health Care / methods*
  • Reimbursement Mechanisms*
  • United States
  • Young Adult