Financing for Collaborative Care—a Narrative Review

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.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

“…Historically, the lack of insurance reimbursement mechanisms for physical-mental health care coordination has been a major barrier to the implementation of integrated care models [ 32 , 33 ]. However, recent innovations have made progress in overcoming this barrier, most notably the Centers for Medicare and Medicaid Services (CMS) behavioral health integration billing codes, which allow primary care providers to bill for mental health care coordination and management services [ 34 ], and the Affordable Care Act Medicaid Health Home waiver, which allows state Medicaid programs to create “health home” programs for subgroups of high-need, high-cost beneficiaries including but not limited to those with SMI [ 35 ].…”

Access to Outpatient Psychiatric Care: One Patient’s Story and a Call to Action

“…The Collaborative Care Model (CoCM) is an evidence-based approach that allows for certain less severe psychiatric disorders, such as mild-to-moderate MDD or generalized anxiety disorder, to be managed in primary care. The model allows patients to more easily—and often, more quickly—access specialty psychiatric care through a care manager, often a social worker ( 16 ). The care manager reviews the patient’s case with a psychiatrist, who provides a recommendation to the patient’s PCP to prescribe.…”

“…In the CoCM, a psychiatrist may review and provide recommendations for perhaps 8 patients in an hour, whereas a psychiatric intake with each patient would have taken between 45 and 60 minutes. Despite the benefits to patients, the CoCM has been slow to expand nationwide, and the lack of reimbursement for the psychiatrist’s consultation time has contributed to this slow uptake ( 16 ). Massachusetts has an opportunity to expand access to psychiatric care for its residents by providing reimbursement for care coordination through MassHealth.…”

“…If the consultation between the care manager and psychiatrist was reimbursable, more health systems may be incentivized to adopt the model. This policy has previously been enacted in Washington and New York states ( 16 ).…”

Eliminating Defects in Behavioral Health Treatment

“…To a large extent, this deficit occurs because clinicians and the systems in which they practice are incentivized almost entirely by volume and throughput rather than by quality and outcomes. Traditional payment models, information systems, and treatment paradigms fail to incentivize keeping people healthy, managing chronic conditions, or coordinating care across the continuum of services (1,2). This is not an indictment of clinicians, who are clearly motivated to improve the lives of the patients they serve.…”