Health Care Reform – What it Means for Behavioral Screening and Intervention (BSI)

By Richard L. Brown, MD, MPH —

It’s official. The healthcare reform law is the law of the land – all two thousand plus pages of it, except for the part that prohibits the federal government from withdrawing all Medicaid funds for states that don’t increase their Medicaid coverage.

This is good news for spreading behavioral screening and intervention (BSI). The law includes requirements that healthplans reimburse for certain preventive services – those that carry Grade A or B ratings from the US Preventive Services Task Force. These services include proactive, universal screening and intervention for tobacco use, alcohol misuse, depression, and obesity, plus counseling on a healthy diet – issues that account for over 40% of deaths, most chronic illness, most disability, and nearly $900 billion in healthcare costs per year. The requirement took effect for many healthplans in 2010, and its effect for all plans in new exchanges on January 1, 2014.

But if the Republicans make gains in the coming election, might the law be repealed or undermined by defunding? Possibly, but BSI increasingly has a life of its own through requirements and incentives in the private sector. For example:

  • Patient-centered medical homes, which command higher reimbursement rates from many commercial healthplans, are increasingly required to implement population health management for behavioral issues
  • Accountable care organizations must meet certain BSI quality requirements, and ACOs get to keep most of the cost savings generated by BSI
  • Employers are increasingly demanding value when they purchase healthcare, and BSI saves $895 per employee through favorable impacts on healthcare costs, productivity, absenteeism, and workplace injuries.

With or without healthcare reform, US healthcare is moving toward payment mechanisms that reward value rather than delivery of services that may or may not improve health outcomes. BSI will inevitably be part of the value-based revolution.

Although not all BSI services are currently reimbursable, several healthcare settings have found they can more than break even when they hire dedicated health educators to deliver BSI. As reimbursement increasingly rewards value, fee-for-service reimbursement for BSI will pale in comparison to BSI’s favorable impacts on outcomes and total costs.

WIPHL is pleased to have continuing funding from the US Agency for Healthcare Research and Quality to help primary care settings implement BSI. Our AHRQ grant allows us to defray ample start-up costs by providing health educator and site training and support at no charge for Wisconsin primary care clinics. We can also advise hospitals and emergency departments.

Wisconsin primary care clinics: WIPHL would be glad to help you get started with BSI. Employers, including local governments: you’ll benefit most, so please steer your local healthcare organizations our way via It’s inevitable – all healthcare settings will deliver BSI. The sooner, the better – for Wisconsin patients, providers, businesses, and state and local governments.

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