Improving Payment for Collaborative Mental Health Care in Primary Care

Abstract

Background: There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492–99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services. Objectives: Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes. Conclusions: Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.

Collaborative care for depression management in primary care: A randomized roll-out trial using a type 2 hybrid effectiveness-implementation design

“…Sessions are typically conducted by telephone, though in-person sessions are available. All CBHP sessions are documented in the EHR and processed through the patient's insurance company [ 44 ]. The BCM also serves as a resource to the PCPs (e.g., external therapy referrals, substance use treatment options) and can provide psychotherapy for a small number of patients in CBHP.…”

“…For example, this program generated top-down (e.g., appropriate financial remuneration for the BCM role in each practice) and bottom-up support (e.g., practice managers and the primary care steering committee supported the administration's decision to move forward with implementation) that will likely confer greater adoption and, ultimately, sustainment of CBHP. Northwestern Medicine Operations will lead the logistic preparation activities such as hiring of BCMs (none previously existed in the system), developing the health information technology infrastructures to support delivery (e.g., patient registry), and establishing EHR-based billing procedures using the CoCM billing codes [ 44 ].…”

“…This economic model is made possible by two factors: negotiating with private and public payers (in 2018 and 2019) to cover CoCM and the recent enactment into law of Illinois bill SB2085 on January 1, 2020, which requires private insurers and Medicaid to cover the costs of CoCM. We have discussed our approach to CoCM billing under CPT codes 99,492–99494 elsewhere [ 44 ].…”

Comparison of Estimated Incentives for Preventing Postpartum Depression in Value-Based Payment Models Using the Net Present Value of Care vs Total Cost of Care

“…Experiences with chronic care management and collaborative care in mental health demonstrate that fee-for-service reimbursement alone may not sufficiently incentivize widespread clinician implementation. 7 , 8 Value-based payment (VBP) offers a promising alternative by providing more flexible, quality-based incentives. Most VBP models, including maternity care models and Accountable Care Organizations (ACOs), offer shared savings based on reductions in the total cost of care (TCOC), a measure of how much was actually spent over the episode or past-year compared with a forecasted benchmark based on an individual’s health risk, with payments modified based on clinician performance on quality measures.…”

Implementation Barriers and Experiences of Eligible Patients Who Failed to Enroll in Collaborative Care for Depression and Anxiety

“…First, CoCM has specially designated Current Procedural Terminology codes. 13 , 14 Since these codes are reimbursed by Medicare, most commercial payers, and a growing number of Medicaid plans, CoCM has a clear pathway to long-term financial sustainability regardless of a health system’s payer mix. Additionally, CoCM can be effective across diverse populations and settings, including managed care organizations, academic medical centers, community-based organizations, and through telehealth delivery.…”