ROI for 30 Years of Preventive Intervention Research: Sustainable State Scale up Funding Strategies Linked with Health Care Reform

The primary issue addressed in this Roundtable is the lack of sustainable funding for infrastructures and systems designed to support scale up of evidence-based behavioral health interventions, particularly scale up that is integrated with health care provision. Related issues concern isolated and inadequate funding streams, weak incentive structures for collaboration among health and behavioral health service providers, and low-level support for workforce development. The end result is that there has been limited return on the past investment in preventive intervention science supported by NIH and other prevention research funders, with many proven interventions mostly “remaining on the shelves.” 

The tremendous social and economic consequences of behavioral health problems are well documented, including an estimated annual cost of $247 billion per year. Given such consequences, the NIH, the CDC, and other federal agencies, as well as private foundations, have invested millions in research directed toward the development, testing, implementation and dissemination of preventive interventions over the past three decades. The positive result is that there are now numerous, wide-ranging evidence-based interventions (or EBIs, over 50 by one estimate) and RCTs have demonstrated the long-term effectiveness of EBI dissemination systems. Partially for this reason, there is an emerging literature on strategies to “move the needle” on EBI scale up. In this context, the Affordable Care Act (ACA) and health care reform have created opportunities for fostering behavioral health EBI scale up through better-integrated behavioral health and health care service delivery. 

This roundtable will focus on addressing the “grand” challenge of behavioral health scale up and associated issues by seizing current funding opportunities created by ACA-driven health care reform, along with development of collective impact approaches, state prevention implementation systems, emerging funding models, and related workforce development. Notably, there are success stories associated with these opportunities. 

Toward this end, the discussants will share their viewpoints and success stories on the following topics.

• State Prevention Funding Models
• Center for Medicare & Medicaid Innovation-Supported State Funding Models
• ACA Community Benefit requirements for non-profit hospital outreach
• ACA support for AAP Bright Futures and reimbursable preventive services
• National health learning collaboratives addressing sustainable state infrastructures
• States’ Accountable Care Organizations/medical home resources
• Application of state university resources to behavioral health prevention workforce development
• Potential National Prevention Council support for networked state prevention systems