A Scoping Review of Strategies for Financing the Implementation of Evidence-Based Practices in Behavioral Health Systems

State of the Literature and Future Directions

Published in: Implementation Research and Practice, Volume 1 (Jan–Dec 2020). doi: 10.1177/2633489520939980

Posted on RAND.org on September 15, 2020

by Alex R. Dopp, Marie-Rachelle Narcisse, Peter Mundey, Jane Frances Silovsky, Allison B. Smith, David Mandell, Beverly W. Funderburk, Byron J. Powell, Susan R. Schmidt, Daniel L. Edwards, Douglas A. Luke, Peter Mendel

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Background

Increased availability of evidence-based practices (EBPs) is essential to alleviating the negative public health and societal effects of behavioral health problems. A major challenge to implementing and sustaining EBPs broadly is the limited and fragmented nature of available funding.

Method

We conducted a scoping review that assessed the current state of evidence on EBP financing strategies for behavioral health based on recent literature (i.e., post-Affordable Care Act). We defined financing strategies as techniques that secure and direct financial resources to support EBP implementation. This article introduces a conceptualization of financing strategies and then presents a compilation of identified strategies, following established reporting guidelines for the implementation strategies. We also describe the reported level of use for each financing strategy in the research literature.

Results

Of 23 financing strategies, 13 were reported as being used within behavioral health services, 4 had potential for use, 5 had conceptual use only, and 1 was potentially contraindicated. Examples of strategies reported being used include increased fee-for-service reimbursement, grants, cost sharing, and pay-for-success contracts. No strategies had been evaluated in ways that allowed for strong conclusions about their impact on EBP implementation outcomes.

Conclusion

The existing literature on EBP financing strategies in behavioral health raises far more questions than answers. Therefore, we propose a research agenda that will help better understand these financing strategies. We also discuss the implications of our findings for behavioral health professionals, system leaders, and policymakers who want to develop robust, sustainable financing for EBP implementation in behavioral health systems.

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