Integrated care, wherein physical and behavioral health needs are treated collaboratively, has resulted in improved patient-level outcomes and has increased screening and treatment of behavioral health disorders within primary care settings by reducing barriers like stigma, access, and accessibility. Despite evidence indicating that behavioral health providers are increasingly likely to be working in integrated primary care settings as part of the interprofessional teams, current national estimates of the percentage of co-located providers is unknown. Additionally, these models may be less prominent in rural and underserved areas and more likely to occur near academic health centers, indicating unequal access to this model of care.
To better understand the rate of co-location of primary care and behavioral health providers working in integrated primary care settings, researchers used the CMS National Plan and Provider Enumeration System (NPPES) downloadable file, a national and publicly available data source, and geo-spatial analysis to report the rate of physical co-location between primary care providers and social workers/psychologists.
This project was co-led by the University of North Carolina-Chapel Hill (UNC) and the BHWRC at the University of Michigan.
Of the 380,690 PCPs in the sample more than 44% were co-located with a behavioral health provider. Providers in urban settings were significantly more likely to be co-located than providers in rural locations (46% vs. 26%, p<.001). Rate of co-location also varied by PCP specialty. Pediatricians, Ob/Gyns, and internal medicine physicians were most likely to be co-located, whereas family medicine and general practitioners were least likely to be co-located. 12% of PCPs who were the sole PCP at an address were co-located compared to 48% of PCPs at medium size practices (11-25 PCPs) and 82% of PCPs in large practices (>25 PCPs). Practice size was also associated with rurality (p<.001) and providers in rural settings were more likely to be in small or single provider practices. Further, PCPs in states that expanded Medicaid were more likely to be co-located than their counterparts.