GIM Professor of Medicine, John Williams, MD, MHS, co-authored a recent online first article in the Journal of General Internal Medicine entitled, Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices.
As background, the collaborative care model involves telephone-based follow-up from a behaviorist care manager and the primary care behaviorist model involves an in-clinic behaviorist. Williams tells us more on how this research contrasting the two came to be, a reflection of the payment structures.
Way back in ancient times, we thought we just needed to screen patients for depression and other mental health disorders and once identified, good things would happen. Turns out we were wrong and I led the first randomized controlled trial to show this.
We then moved on through a series of studies to better understand the problem. Once we understood the multitude of barriers to high quality depression care – in primary care – we tested a new model – the collaborative care model (modeled in the current study). It worked! Then we turned to – how can we scale up and implement widely? Turns out, this is really difficult and a key barrier is the current reimbursement mechanisms in medicine. There was simply no way to pay for the care managers – who are the critical new clinician in these teams. The new CMS “g-codes” were created and went live in January of this year to pay for the services provided by these care managers.
Our study was to determine the overall effects of using these new codes on the financial outcomes for primary care practices. It turns out, they can do well by implementing collaborative care models under almost any scenario we could dream up. I think this is a really important finding. It will speed up national implementation of these programs, improve patient outcomes and decrease PCP burnout.
Basu S, Landon BE, Williams JW, Bitton A, Song Z, Phillips RS. Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices. J Gen Intern Med. 2017. PMID: 28900839 [Link]