Measuring Productivity in Primary Care Behavioral Health: A Delphi Study

Area of Science:

• Healthcare Management
• Behavioral Health Services
• Primary Care Integration

Background:

• High productivity of behavioral health consultants (BHC) is key to the primary care behavioral health (PCBH) model for maximizing patient access.
• Traditional productivity targets in healthcare may not be optimal for all settings.

Purpose of the Study:

• To achieve expert consensus on an operational definition and metrics for high productivity among BHCs within the PCBH model.
• To identify factors influencing BHC productivity in integrated primary care settings.

Main Methods:

• A modified Delphi technique involving clinicians, managers, and researchers in PCBH.
• A multi-round survey to gather and refine consensus on 28 potential productivity metrics and influential factors.

Main Results:

• Two direct metrics (average daily billable visits, patients seen daily) achieved >80% consensus as essential for measuring BHC productivity.
• Practice integration level was deemed highly influential (>80% consensus), with other factors showing varied agreement.
• Participant comments highlighted the importance of high patient volume and numerous practice-level influences on productivity.

Conclusions:

• Expert consensus supports specific direct metrics for BHC productivity, acknowledging the role of patient volume.
• The level of practice integration significantly influences BHC productivity.
• Further research is needed to validate these metrics in practice and explore patient, clinician, and practice-level moderators of productivity.