October 02, 2019
Nicole Andrews, MPH, PCDC, recently discussed the elements of the collaborative care model at Heath Care Quality Congress 2019, and she explained the models impact on health care cost and analyzed payment incentives for integrating the model.
According to Ms Andrews, the collaborative care model is, “a systematic approach to the treatment of depression and anxiety in primary care settings that involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to more proactively manage mental disorders as chronic diseases, rather than treating acute symptoms.”
She explained that there are four core elements of the model. They include:
- Patient-centered teams;
- Measurement based treatment;
- Population-based care; and,
- Evidence-based care.
Ms Andrews said that the care teams are comprised of multiple people in order to collaborate effectively using shared care plans that incorporate patient goals. The members include the treating or billing practitioner, a behavioral health care manager, psychiatric consultant, and the beneficiary themselves.
Ms Andrews then provided some quick facts for the audience regarding health care costs. She said that in 2017, patients with behavioral health conditions cost an estimated $725 billion. Further, she noted that $26-48 billion could be saved annually in general health care costs if there is effective integration of medical and behavioral health care.
She asked, “so, what are we saving? What are we looking at?”
She said that the projected health care cost savings through effective integration are as follows:
- Commercial: $19.3-$38.6 billion;
- Medicare: $6.0-$12.0 billion;
- Medicaid: $12.3.=$17.2 billion; and,
- In total: $37.6-$67.8 billion.
Next Ms Andrews discussed the IMPACT model. The IMPACT study, was a 12-month collaborative care management program for elderly patients with depression.
“The program was administrated through a randomize clinical trial that compared a collaborative are intervention using teams of depression care managers, primary care doctors, and psychiatrists in the usual care for depressions,” she explained. “Total health care costs were tracked for a 4-year period following the intervention, and costs for the intervention group were lower than costs for those receiving standard care.”
“Patients in the collaborative care management program had lower costs in every category that was observed, and the results of a bootstrap analysis indicated that patients in the collaborative care program were 87% more likely to have lower total health care costs than those receiving usual care.”
She noted that the findings of the IMPACT study represent 10% of total health care costs for the intervention group over a four-year period.
“This is my favorite thing to talk about,” she said while moving on to the next topic of her session. “What do we have to do to be reimbursed?”
She explained that through this model, primary care providers (PCP) must perform and bill separately for an initial preventative physical, followed by an annual wellness exam. Additionally, each eligible patient must have a written care plan. This must include 20 minutes spent each month on care coordination for each patient by a licensed care team member. Patients must also have 24/7 access for urgent care needs, which include telephone consultation. She noted that the team is responsible for hospital post discharge and emergency department follow-up.
Additionally, PCPs must also oversee all EHR activity such as maintain documents, review charts, and update medical records, she explained.
“This is important,” she noted. “This is why people are losing money.”
Finally, she said, and most critically, the physician must get the patient’s written consent to act as care coordinator. She said this is important because the service is subject to a Medicare deductible.
Finally, Ms Andrews highlighted how health plans can help facilitate care integration and support many of these integration enablers through various ways. She said these ways include:
- Reimbursing providers for integrating medical and behavioral care;
- Developing adequate behavioral networks with high-value provides;
- Connect local medical and behavioral providers to build optimal local relationships; and,
- Encourage use of various technologies and telemedicine services to improve care coordination while expanding access.
Finally, she said that there are four steps for success with the Collaborative Care Model.
She said to “engage providers, incentive providers, encourage providers, and reimburse providers.”