Abstract
Purpose of review: Collaborative care (CoCM) is an evidence-based model for the treatment of common mental health conditions in the primary care setting. Its workflow encourages systematic communication among clinicians outside of face-to-face patient encounters, which has posed financial challenges in traditional fee-for-service reimbursement environments. Recent findings: Organizations have employed various financing strategies to promote CoCM sustainability, including external grants, alternate payment model contracts with specific payers, and the use of billing codes for individual components of CoCM. In recent years, Medicare approved fee-for-service, time-based billing codes for CoCM that allow for the reimbursement of patient care performed outside of face-to-face encounters. A growing number of Medicaid and commercial payers have followed suit, either recognizing the fee-for-service codes or contracting to reimburse in alternate payment models. Summary: Although significant challenges remain, novel methods for payment and cooperative efforts among insurers have helped move CoCM closer to financial sustainability.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 334-344 |
| Number of pages | 11 |
| Journal | Current Treatment Options in Psychiatry |
| Volume | 5 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2018 |
Funding
Department of Health Management and Education [21]. Another academic implementation at the University of Washington, termed the Behavioral Health Integration Program (BHIP), has been funded through a combination of public insurance billing, commercial billing, and internal support [25]. Montefiore Medical Center in New York funded a similar program partially through a CMS Health Care Innovation Award [26]. The multi-center and geographically diverse Care of Mental, Physical and Substance-use Syndromes (COMPASS) study was the first large-scale implementation initiative for TEAMcare [27], which adapted the CoCM model for patients with depression and chronic medical illness. This effort was financed through a Center for Medicare and Medicaid Innovation (CMMI) grant, although each participating organization developed its own plan for sustainable funding after completion of the study [28]. A number of managed care organizations, such as Group Health (now Kaiser Permanente of Washington State) [29] and Intermountain Healthcare [30,31], have invested significant portions of their discretionary health care dollars in CoCM and behavioral health integration more broadly. Other CoCM programs have been primarily funded through grants that include (but are not limited to) the MacArthur Initiative on Depression and Primary Care at Dartmouth and Duke, the Health Resources and Service Administration (HRSA) Behavioral Health Service Expansion Funding, the Hogg Foundation for Mental Health Integrated Health Care Initiative, the ICARE Partnership, and the RWJF Depression in Primary Care National Program [32]. Dr. Carlo was supported by a post-doctoral fellowship from the National Institute of Mental Health (T32 MH20021 Psychiatry–Primary Care Psychiatry Fellowship Program Training Grant). The Washington State Mental Health Integration Program (MHIP), which began in 2007, was financed through a partnership between the State of Washington, the Community Health Plan of Washington, more than 100 community health clinics, and 30 community mental health centers throughout the state [33]. Until 2018, it was funded by the State of Washington and administered by a non-profit managed care plan, the Community Health Plan of Washington (CHPW), in collaboration with the Public Health Department of Seattle and King County. Initially, MHIP provided CoCM for unemployed adults, the temporarily disabled, veterans and their family members, the uninsured, low-income mothers, children, and other older adults [33]. In addition to traditional fee-for-service payments to primary care providers who saw patients face-to-face, participating clinics received lump sum payments for on-site care managers adjusted by caseload size [33]. This funding strategy was employed, in part, due to results from prior research on chronic physical disease that found case rate payments to be the most practical and straightforward way to reimburse for the care management of patients with complex, chronic needs [16,34]. Additionally, psychiatric consultants received contract payments from CHPW for systematic review of CoCM caseload patients and treatment recommendations to the patients’ primary care providers (PCPs). Beginning in 2009, due to concern for substantial variation in quality and outcomes across the participating community health clinics, a pay-for-performance initiative was implemented to make a portion of the program funding to participating clinics
Keywords
- Collaborative care
- Financial sustainability
- Health policy
- Health service reimbursement
- Healthcare financing
ASJC Scopus subject areas
- Clinical Psychology
- Psychiatry and Mental health
