Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE)

SHAPE is a 3-year project that aims to examine the effect of paying for the integration of behavioral health and primary care through a global payment. Actuarial modeling will study its sustainability and benefit to the practice and community.  In determining the payment to integrated providers, the following factors will be considered:

• Cost: The total cost of compensation to the behavioral health providers, related clinical and population interventions must be taken into account. Failure to cover the cost of personnel and services will undermine integration and/or trigger a reversion to FFS "revenue generation".
• Panel Size: A larger practice panel may require more integrated services and patient supports. Under resourced practices will make a smaller impact upon population health and total cost -- even if interventions are prioritized appropriately.
• Panel Complexity: Patients with greater needs require greater support. Payments should be 'risk adjusted' to afford the time and focus to serve patients with complex conditions and circumstances -- before, during and after patient encounters. Risk adjustment and panel stratification functions must enable the practice to systemically predict, prioritize and prevent.
• Program Design and Alignment: Payments should be contingent upon measured adherence to evidence and best practices, and alignment with identified needs and gaps in the entire patient panel.