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Implementation of Combined PCBH and CCBHC Models: Key Considerations

Integrated Care News by CFHA

On January 7, 2025, SAMHSA announced the award of one-year Certified Community Behavioral Health Clinics (CCBHCs) Demonstration planning grants to 14 states and Washington, D.C., Consider a tiered approach where generalist BHCs work within primary care while specialists manage higher-acuity cases through the CCBHC framework.

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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. Objective: Our objective was to improve the TCM clinic no-show rate and thereby improve patient outcomes.

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Patient experiences navigating US healthcare with long-COVID - Part 3 of 3 [COVID-19]

Annals of Family Medicine

Context: For many patients with long-COVID, primary care is the first point of interaction with the healthcare system. In principle, primary care is well-situated to manage long-COVID. However, beyond expressions of disempowerment, the patient’s perspective regarding the quality of long-COVID care is lacking.

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Pilot Testing of the Treatment Burden Screening in Diabetes Tool in Primary Care [Multimorbidity]

Annals of Family Medicine

Context: Nearly all patients with type 2 diabetes have comorbid chronic conditions, adding complexity to self-management. A tool to more efficiently relay points of patient-perceived treatment burden during a primary care visit may lead to more patient-centered care plans and improved outcomes.

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Ambulatory Behavioral Health Referral Patterns in the Setting of Chronic Medical Conditions [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

Context: Patients with chronic medical conditions (CCs) and behavioral comorbidities have lower quality of life and increased healthcare expenses. Our work builds a foundation for cost-effective workflows to support patients with multimorbidity. 8% (n= 1,146) were ordered for medical condition management.

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How to Improve Care for Patients With Multiple Chronic Conditions

Physician's Weekly

Caring for patients with multiple chronic conditions requires identifying those at risk, clear communication, and coordinated care to improve outcomes. Many of these patients are clinically complex and receive care from multiple professionals—which creates unique management hurdles.

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Provider Attitudes Regarding Osteopathic Manipulative Medicine: A Qualitative Study [Practice management and organization]

Annals of Family Medicine

Context: Currently, only 43% of doctors of osteopathic medicine (DOs) nationwide offer osteopathic manipulative treatments (OMT), with half of them providing OMT to ≤5% of their patients. Objective: This study investigates provider attitudes toward OMT and identifies barriers to referrals to address the unmet patient demand.