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Opportunities for Financial Sustainability - Behavioral Health Integration Into Physician Practices

Posted: 12/07/2018
Category: Practice Management

With the increasing emphasis on total cost of care and BH Integration being included in many reform initiatives (DSRIP, NYSPCMH, MIPS/MACRA), physicians are looking for ways to address BH issues in their practices. Historically, the reimbursement for BH Integration has been lacking, making sustainability difficult, but recent changes at the state and federal level provide additional reimbursement for primary care practices providing evidence-based integrated care.

The Collaborative Care Model (CC) is the most evidence-based approach to integrating Behavioral Health services into Primary Care. CC is based on the chronic care model, applying the chronic disease framework of treat to target to BH diagnoses. In the same way you would monitor the A1c of a patient with diabetes, you monitor a patient’s PHQ-9 over time. This provides a framework for both patients and providers to see improvement or identify when a treatment isn’t working. All of this is done with the support of an embedded BH professional. This provider works with the PCP as part of the primary care team to provide care management and brief therapeutic interventions.  CC practices also have the support of a psychiatric consultant that can provide input on patients that are not improving and provide PCPs with support for psychopharmacology.

The CC model, though very effective, does not fit into most traditional reimbursement models. The NYS Office of Mental Health developed a new reimbursement mechanism to address some of the challenges of the current financing system. The NYS Collaborative Care Medicaid Program provides a monthly case rate reimbursement for primary care providers following the CC model of integration. The monthly payment of $112.50 allows physicians to cover costs of the services involved in integrated care that are not otherwise billable. This monthly rate can be layered on top of other services provided such as screening. As of 2018, CMS announced Medicare CPT codes for Collaborative Care as well, and many commercial plans are paying for these CPT codes now. These CPT codes are also a monthly rate, like the NYS Medicaid Program. 

A breakdown of the Medicare payment can be found here

The NYS OMH also offers free implementation training and support to help practices get up and running with the CC model and take advantage of these payment opportunities. For more information, contact amy.jones@omh.ny.gov

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