Configuring health care for systematic behavioral screening and intervention

Area of Science:

• Public Health
• Preventive Medicine
• Health Services Research

Background:

• The United States Preventive Services Task Force recommends universal screening and intervention for tobacco use, excessive drinking, and depression.
• These behavioral conditions are prevalent and impact health outcomes, healthcare costs, and public safety.
• Integrating evidence-based interventions into busy healthcare settings presents significant challenges.

Purpose of the Study:

• To propose a systematic approach for integrating behavioral screening and intervention (BSI) into healthcare settings.
• To outline a 2-tiered, stepped-care model for delivering BSI services.
• To identify cost-efficient providers for delivering first-tier BSI services.

Main Methods:

• A 2-tiered, stepped-care model is proposed for BSI delivery.
• Tier 1 services include assessment, intervention, and follow-up for mild-to-moderate conditions.
• Tier 2 services involve specialty-based resources for patients with the greatest need.

Main Results:

• Health educators, with enhanced training, are proposed as cost-efficient providers for Tier 1 services.
• The model aims to systematically provide BSI, aligning with medical home and chronic care models.
• Implementation is expected to improve health outcomes and generate cost savings.

Conclusions:

• The proposed 2-tiered model offers a scalable solution for integrating BSI into healthcare.
• Expanding healthcare benefits with systematic BSI can lead to significant population health improvements.
• This approach supports the realization of improved health outcomes and cost savings in the US.