Participation in delivery system reform programs and U.S. acute care hospital integration into behavioral health

Background: Growing recognition of the prevalence and consequences of behavioral health disorders has reinvigorated efforts to transform how behavioral health is delivered, especially amongst acute care hospitals, and stimulated discussions about the ways to support these efforts. The purpose of this study was to examine the relationship between hospital participation in two delivery system reform programs-Accountable Care Organizations (ACO) and medical homes-and behavioral health integration among United States' acute care hospitals. Methods: The study used a pooled, cross-sectional analysis with the hospital as the unit of observation. Our primary analysis utilized a negative binomial regression model to examine the relationship between hospital participation in delivery system reform programs and the breadth of behavioral health integration. Our secondary analysis used four binary logistic regression models to assess whether participation in delivery system reform programs was associated with behavioral health integration in specific areas of the hospital. Results: On average, hospitals that were only participating in an Accountable Care Organization reported 1.09 times more behavioral health integration areas, relative to hospitals that were not participating in any delivery system reform programs (IRR =1.09, P<0.05). Similarly, hospitals with an established medical home program reported 1.21 times more behavioral health integration areas, on average, relative to hospitals that were not participating in any delivery system reform programs (IRR =1.21, P<0.001). Hospitals that were participating in both an Accountable Care Organization and had an established medical home program reported 1.31 times more behavioral health integration areas, relative to hospitals with neither (IRR =1.31, P<0.001). Conclusions: Our analysis indicates that participation in either an Accountable Care Organization or medical home program, by itself, may be sufficient to support behavioral health integration, however, having an established medical home program may stimulate more robust integration than Accountable Care Organization participation. Likewise, hospitals participating in both programs may promote even greater behavioral health integration than single program participation. Collectively, our findings highlight opportunities to improve behavioral and physical health integration by U.S. acute care hospitals.