Financing Strategies for Collaborative Care

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There are innovative ways to finance a collaborative care program in your organization. Below are opportunities and examples of financing a collaborative care program.

2017 CMS G Codes for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services announced final rules for Medicare payments for services provided by primary care providers for patients participating in a collaborative care program or receiving other integrated behavioral health services. The payment structure may be used to treat patients with any behavioral health condition that is being treated by the billing practitioner, including substance use disorders. At this time, FQHC- and RHC-designated practices may not bill these codes. To learn more, download the AIMS Center's 2017 CMS Medicare Payment Codes Cheat Sheet and read the New England Journal of Medicine's article, "Medicare Payment for Behavioral Health Integration."

The Minnesota DIAMOND Initiative Multi-Payer Strategy
The Institute for Clinical Systems Improvement (ICSI) launched its DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) depression collaborative care program model in 2008. More than 12,000 patients had received treatment through the DIAMOND as of April 2013. Through ICSI, the DIAMOND Steering Committee designed a payment model to be used by nine collaborating health plans to support the initiative. All participating payers agreed to use a single billing code for DIAMOND services established for certified DIAMOND clinics. The code covers care manager services on a monthly basis, including weekly consultation and case review by a psychiatrist.

Washington State Mental Health Integration Program
Washington State’s Mental Health Integration Program (MHIP) was established in 2008 with support from the Community Health Plan of Washington and tax levy funds contributed by Seattle-King County government. In this unique financing model, the two payers contribute funds to support most of the costs of collaborative care manager positions at participating clinics, but a significant portion of the funds are withheld until participating clinics achieve agreed upon quality aims such as depression remission response. The MHIP quality aims are one of the first examples of value-based purchasing in a large integrated mental health care program. MHIP has served over 50,000 patients throughout Washington State since 2009.

New York State Collaborative Care Medicaid Program
The New York State Collaborative Care Medicaid Program, established in 2015, is the first Medicaid program in the United States to offer a monthly case rate for collaborative care services. Similar to the DIAMOND Initiative and CMS G codes, the New York State Office of Mental health (OMH) offers a single case rate for services. The case rate code bundles payment for care manager services, psychiatric consultation and case review. The case rate is offered as an interim financing strategy as the state begins its transition to value-based purchasing.

Accountable Care and Value-Based Purchasing Strategies
Many large healthcare purchasers such as the Boeing Company have already including clinical outcomes measures for depression in their shared savings and at risk contracts with Accountable Care Organizations (ACO). As a result, ACO are learning to be outcomes-focused and learning to deliver on quality and value, not quantity of services. The new 2017 HEDIS depression remission and response measures is of particular interest to payers and purchasers as they continue to define and refine behavioral health outcome metrics for value-based purchasing.