Cracking the codes: state Medicaid approaches to reimbursing psychiatric collaborative care
- Collection:
- Health Policy and Services Research
- Author(s):
- Raney, Lori, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, California] : California Health Care Foundation, September 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Insurance, Health, Reimbursement Medicaid -- economics Mental Health Services -- economics Delivery of Health Care, Integrated United States
- Genre(s):
- Technical Report
- Abstract:
- Integrating behavioral health into primary care is an important way to increase access to effective behavioral health treatment while maximizing the capacity of our very limited behavioral health workforce. There are many approaches to integration, but the Collaborative Care Model (CoCM) has the most robust evidence base, especially for anxiety and depression. Compared to the usual primary care approach to managing behavioral health needs, in which a provider either refers the patient to a specialist or manages needs on their own, CoCM offers supports for the providers and delivers superior clinical outcomes for common, less complex behavioral health conditions. In 2002, one of the earliest significant trials of CoCM, known as Improving Mood Promoting Access to Collaborative Treatment (IMPACT), demonstrated that the model doubles the effectiveness of the treatment of depression in elderly adults. Since then, more than 80 randomized controlled trials have demonstrated CoCM's clinical effectiveness for patients across many age groups, races, and ethnicities and with a range of common diagnoses, including depression, anxiety, PTSD, attention deficit hyperactivity disorder, and substance use disorder. The trials also showed the model could work in both rural and urban settings and across multiple payers including Medicaid. Furthermore, CoCM proved cost-saving, returning $6.50 for every dollar spent according to one study looking at older adults and demonstrating savings in multipayer populations with diabetes and depression. Less is known about the model's cost-effectiveness in Medicaid, an important avenue for future inquiry given the strong evidence of its clinical effectiveness for low-income populations. Researchers also wanted to demonstrate that CoCM could be effective outside the controlled and rigid environment of a randomized trial. In 2012, the Centers for Medicare & Medicaid Services (CMS) funded a large study of real-world CoCM implementation spanning multiple community settings in eight states, including California, and reaching more than 3,000 patients. That randomized trial, known as Care of Mental, Physical and Substance-use Syndromes (COMPASS), revealed two key findings: (1) CoCM was about as clinically effective in the real world as in prior trials, and (2) CoCM could not be sustainably financed without new billing codes to support the work of the collaborative team, as illustrated in Figure 1. In response to the latter finding and feedback from stakeholders, CMS ultimately created a set of new billing codes unique to CoCM and issued them in 2016. When new codes are released by CMS, they can be immediately used by providers for Medicare enrollees, but state Medicaid agencies and commercial carriers make independent decisions regarding if, when, and at what rate they will reimburse the new codes. Those non-Medicare payers can also choose to add their own requirements or restrictions to the codes. Currently, the majority of commercial carriers reimburse for the CoCM codes, also known as the Psychiatric Collaborative Care Codes, but just 17 state Medicaid agencies do. This uneven adoption of CoCM codes among payers is a barrier to the model's spread, as evidenced by financial modeling studies showing that CoCM only becomes economically viable for a practice when all payers reimburse the codes. If more of these payers adopt the codes, the hope is more practices will in turn adopt CoCM, and ultimately, more patients will benefit. This paper examines the progress of states whose Medicaid agencies are reimbursing the CoCM codes to identify lessons learned and best practices, and to inform the approaches of other states in the future. While the focus of this paper is on state-level implementation, the approaches and lessons learned also apply to individual Medicaid managed care plans, which have the flexibility to pay for integrated care using these codes or other value-based payment approaches in many states. For example, at least one of Oregon's Medicaid Coordinated Care Organizations has elected to reimburse the codes, and in Chicago, the Medical Home Network accountable care organization reinvested savings from its risk-based payer contracts to implement collaborative care.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (27 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101771905 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101771905