Cost Savings from Integrating Behavioral Health in Primary Care: A Pragmatic Randomized Control Trial with Karen Refugees

Many refugees experience exposure to chronic and traumatic stressors that can lead to complex mental health and other health care needs. The integration of behavioral health into primary care is a promising approach for addressing complex health needs; however, it has been understudied with refugee and immigrant populations. Using a pragmatic randomized control trial design, this study examined inpatient and outpatient health service utilization and associated costs of a primary care-based intensive psychotherapy and case management intervention for 214 Karen refugees with major depression compared to care as usual over time. Results indicated the addition of the behavioral health intervention was associated with reduced inpatient healthcare costs vs. care as usual, shorter hospital stays, and improved patient status at discharge. The average inpatient cost saving exceeded $8,000 per patient among the intervention group. After controlling for key patient characteristics, patients who received the intervention accrued lower outpatient costs as compared to care as usual over 18 months. Findings suggested the integrated behavioral health intervention resulted in lower healthcare costs among refugees with complex health needs engaged in primary health care. Future research is needed to better understand long-term effects and further optimize care for refugees. Trial Registration clinicaltrials.gov Identifier NCT03788408. Registered 20 Dec 2018. Retrospectively registered.