Virtual Behavioral Health Integration (VBHI)

An Evaluation of Virtual Behavioral Health Integration Into Primary Care

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.

Study Overview

• Status: Completed
• Conditions: Depression; Anxiety; Substance Use Disorder
• Intervention / Treatment: Behavioral: Virtual Behavioral Health Integration

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 5777
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Albemarle, North Carolina, United States, 28001
      • Albermarle Medical Services
    • Charlotte, North Carolina, United States, 28226
      • Charlotte Medical Clinic Arboretum
    • Charlotte, North Carolina, United States, 28262
      • North Charlotte Medical Specialists Huntersville
    • Charlotte, North Carolina, United States, 28278
      • Mecklenburg Medical Group - Steele Creek
    • Concord, North Carolina, United States, 28035
      • NorthEast Internal and Integrative Medicine
    • Denver, North Carolina, United States, 28037
      • East Lincoln Primary Care
    • Gastonia, North Carolina, United States, 28056
      • Riverwood Medical Associates
    • Harrisburg, North Carolina, United States, 28075
      • Ardsley Internal Medicine - Harrisburg
    • Indian Trail, North Carolina, United States, 28079
      • Dove Internal Medicine Union West
    • Indian Trail, North Carolina, United States, 28079
      • Indian Trail Family Medicine
    • Kannapolis, North Carolina, United States, 28081
      • Kannapolis Internal Medicine
    • Kings Mountain, North Carolina, United States, 28086
      • Kings Mountain Internal Medicine
    • Lincolnton, North Carolina, United States, 28092
      • West Lincoln Family Medicine
    • Monroe, North Carolina, United States, 28112
      • Dove Internal Medicine - Monroe
    • Monroe, North Carolina, United States, 28112
      • Union Family Practice
    • Mooresville, North Carolina, United States, 28117
      • Mooresville Internal Medicine Associates
    • Oakboro, North Carolina, United States, 28129
      • Oakboro Medical Services
    • Richfield, North Carolina, United States, 28137
      • Richfield Medical Services
    • Shelby, North Carolina, United States, 28150
      • Shelby Family Practice
    • Wesley Chapel, North Carolina, United States, 28104
      • Union Primary Care

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Behavioral Health Integration; 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; 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.
No Intervention: Usual Care - Behavioral Health; 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?

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

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start (Actual): August 14, 2019
• Primary Completion (Actual): February 8, 2021
• Study Completion (Actual): May 8, 2021

Study Registration Dates

• First Submitted: September 24, 2019
• First Submitted That Met QC Criteria: September 25, 2019
• First Posted (Actual): September 27, 2019

Study Record Updates

• Last Update Posted (Actual): April 25, 2022
• Last Update Submitted That Met QC Criteria: April 19, 2022
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: IRB00082499; 08-19-24E (Other Identifier: Atrium)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No