The Department of Defense (DoD) was one of the original adopters of the Primary Care Behavioral Health (PCBH) model. Over 20 years ago, the United States Air Force (USAF) piloted its “Behavioral Health Optimization Program” or BHOP at a single Air Force Base. Since 1997, the program has expanded across 72 Air Force facilities and since 2013 has been incorporated into medical care across all DoD services. While there are many unique features of the Military Health System (MHS), its beneficiaries, which include not only Active Duty service members, but also retirees and their families, represent a diverse cross-section of America. DoD facilities are scattered throughout the United States, in populous cities and rural towns. As such, the USAF provides an ideal setting to study aspects of integrated care that apply across the diverse healthcare landscape.
A recent study published in Translational Behavioral Medicine describes the results of a quality improvement project undertaken by the USAF using PCBH within a stepped care framework. Three treatment facilities, chosen across the country to represent both rural and urban care facilities (ranging from 13,000 beneficiaries up to over 54,000), participated in this pilot. Without any additional resources (e.g., no hired staff), these clinics reallocated a behavioral health provider and behavioral health technician (equivalent to a medical assistant with exclusive behavioral health training) from specialty mental health to primary care. They also ran an aggressive marketing campaign to funnel new patients into primary care as opposed to specialty mental health. In one year, these sites doubled the number of behavioral health encounters, reached 150% more of the beneficiary population, and saved community mental health costs by over $100,000. These results far outpaced their peer institutions while maintaining high levels of patient satisfaction.
Read the study here https://academic.oup.com/tbm/advance-article/doi/10.1093/tbm/iby046/4992907?guestAccessKey=9d8e2439-75a6-42b6-a336-466351261f2e to learn more about this innovation.
Ryan R. Landoll, Ph.D., ABPP, is the Assistant Dean for Preclinical Sciences at the Uniformed Services University. His research broadly focuses on two main topic areas: primary care behavioral health, and adolescent peer relationships (i.e., romantic relationships, friendships, and peer victimization, including cyber victimization) and internalizing disorders (i.e., social anxiety, depression). Dr. Landoll currently heads the Military and Sexual/Reproductive Health (MARSH) Research Program at the Uniformed Services University.