Where is Behavioral Health Integration Occurring? Using NPI Data to Map National Trends
Investigators: Erica L. Richman, PhD, MSW, Brianna Lombardi, PhD, MSW, Lisa de Saxe Zerden, PhD, MSW, Randy Randolph, MRP
Issue: Because most primary care visits include a behavioral health component, providing integrated services is now considered a priority for health systems to meet patient needs. Integrated care is a model where behavioral healthcare workers work on teams with primary care physicians (PCPs) to help address behavioral and social determinants of health alongside physical health. Co-location, where both types of providers work in the same physical space, is one key element of integration. Little is known about the rate of expansion of co-located services in the U.S. since the passing of legislation and increased federal funding incentivizing co-location.
Methods: This study was undertaken in collaboration with the Behavioral Health Workforce Research Center at the University of Michigan. National Plan and Provider Enumeration System data were used for analyses. PCPs reporting at least one of five specialties were included (family medicine, general practice, internal medicine, pediatrics, and obstetrics/gynecology). Behavioral health providers were limited to social workers and clinical psychologists. Provider practice addresses were geocoded to latitude and longitude coordinates using the Environmental Systems Research Institute StreetMap database and ArcGIS software. The geocoding system provided information on the quality of each geocoding result and an algorithm was applied to choose the best address. Straight-line distances between practice locations of behavioral health providers and PCPs were summarized and distances <0.01 miles were considered co-located.
Findings: Of the 380,690 PCPs in the sample, >44% were co-located with a behavioral health provider. Providers in urban settings were much more likely to be co-located than providers in rural locations. Smaller practices were significantly less likely to be co-located than larger ones and were more likely to be located in rural settings. Rate of co-location varied by PCP specialty; pediatricians, obstetricians/gynecologists, and internal medicine physicians were most likely to be co-located, whereas family medicine and general practitioners were least likely to be co-located.
Discussion: Co-location is occurring less frequently in rural settings and in smaller practices; these are the practices that will need greater assistance achieving integrated healthcare. Increasing rates of co-location by incentivizing behavioral healthcare providers to work alongside physicians could reduce physician burnout by minimizing the rural physician’s scope of practice and potentially reduce feelings of seclusion. The health workforce must be trained to work in integrated settings and understand how practice can incorporate both physical and behavioral health needs concurrently.
- Richman EL, Lombardi BM, de Saxe Zerden L. Mapping Co-Location: Using National Provider Identified Data to Assess Primary Care and Behavioral Health Co-Location. Families, Systems, & Health. 38(1):16-23. March 2020.
- Zerden LD, Lombardi BM, Richman EL. Social workers on the interprofessional integrated team: Elements of team integration and barriers to practice. Journal of Interprofessional Education & Practice. 2019 Dec 1;17:100286.
- Richman EL, Lombardi B, Zerden de Saxe L, Lombardi B, Randolph R. Where is Behavioral Health Occurring? Mapping National Co-Location Trends Using National Provider Identifier Data. University of Michigan Behavioral Health Workforce Research Center. November 2018.
- Richman E, Lombardi B, de Saxe Zerden L, Randolph R. Where is behavioral health integration occuring? Mapping national co-location trends using national provider identified data. Behavioral Health Workforce Research Center. University of Michigan. Policy Brief. November 2018.
- Richman E, Zerden LD, Lombardi BM, Randolph R. Where is Behavioral Health Integration Occurring? Mapping National Co-location Trends Using National Provider Identifier Data. Association of American Medical Colleges Health Workforce Research Conference. Alexandria, Virginia. May 2019.
- Richman, E., Zerden, L.D., Lombardi, B.M., Randolph, R. (2019). Where Is Social Work Behavioral Health Integration Occurring? Using NPI Data to Map National Trends in Co-Location. Oral Presentation, Society for Social Work and Research 23rd Annual Conference, San Francisco, CA.
- Richman, E., Lombardi, B. M., Zerden, L. D. (2019 June). Mapping Co-Location: Using National Provider Identified Data to Assess Behavioral Health Co-Location. Poster Presentation, 2019 Academy Health Workforce Meeting, Washington, DC.
- Richman E, Lombardi B, Zerden L. Where is Behavioral Health Integration Occurring? Using NPI Data to Map National Trends of Co-Location. APHA’s 2019 Annual Meeting and Expo (Nov. 2-Nov. 6) 2019 Nov 4.