Cost offset: Past, present, and future.

Abstract

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector.

Integration: Opportunities and Challenges for Family Therapists in Primary Care

“…Eventually, organizational startup costs are fully offset by savings in medical costs (Levant et al 2006). This phenomenon has been found by most of nearly 100 published studies (Levant et al 2006). Research teams studying family therapy, specifically, in primary care have found 21 % cost savings in general populations (Law and Crane 2000).…”

“…Since the 1960s, these initial expenses have been shown to slowly change to cost savings of about 25 % as clinical outcomes improve, making care more efficient by decreasing the need for services (Chiles et al 1999(Chiles et al , 2002Crane and Christenson 2008;Cummings 2001;Cummings et al 1997;Follette 1968, as cited in Cummings 2001;Law and Crane 2000). Eventually, organizational startup costs are fully offset by savings in medical costs (Levant et al 2006). This phenomenon has been found by most of nearly 100 published studies (Levant et al 2006).…”

“…MedFTs have a place in the integrated care system but need to understand that, in the absence of policy change, barriers impacting most BHPs will continue to curtail integration (Blount 2003;Dickinson and Miller 2010;Kathol et al 2010;Levant et al 2006). The 'Three World View' framework (Peek 2008;Peek andHeinrich 1995, 1998) offers a structure for reviewing each barrier and identifying where changes are needed.…”

“…The cost of adding specially trained BHPs in a reimbursement system where their services are 'carved-out' from medical care is perhaps the most frequently cited barrier to integration (Hodgkin et al 2000;Kathol et al 2010;Levant et al 2006;Robinson and Strosahl 2009). Sometimes administrators bypass this issue by starting grant-funded or studentvolunteered pilot projects that achieve clinical and operational success.…”

“…Full CMS recognition will allow therapists to independently use Health and Behavior Codes (H&B). H&B codes are a fairly recent strategy that improves sustainability by allowing same-day billing by PCPs for medical components of care and BHPs for psychosocial components of care related to the physical diagnosis (Kessler 2008b;Levant et al 2006;Miyamoto 2006). These codes allow BHPs to bill for treatment of issues that affect patients' health (e.g., coping with a new diabetes diagnosis) but do not meet criteria for a DSM-IV-TR (DSM-IV; American Psychiatric Association 2000) diagnosis.…”