Novel approaches to providing access to behavioral health care, like collaborative care and integrated behavioral health primary and social care models, have shown short and long-term positive patient and family outcomes in frontier, rural, and urban communities. These approaches are complex and rely upon coordination, systems-based management, efficient communications, team and community relationships, and virtual access to critical information. Development and expansion of these models requires a workforce with the social and professional skills and credentials to deliver this type of behavioral health care in various settings. Estimating the costs of and payment for these novel models of care will further develop the workforce needed to expand and sustain delivery of evidence-based behavioral health services.
This study documents a sample of existing behavioral health care models, required workforce, and current financing. A resource use model explores existing and proposed fee, bundled, value-based, and capitated payment models. This study helps to inform managers and policy makers at the local, state and federal levels of viable financing arrangements to promote these and future novel approaches to delivering high quality, accessible, sustained behavioral health care to communities and vulnerable populations.
Researchers developed a resource use model to conceptualize how cost varies by integrated care setting as a function of care team compositions, patient severity, and geography. This model captures the per-unit/per-patient cost of providing integrated care services, and is applicable to both integrated care and collaborative care programs.
Secondly, researchers described actual cost for integrated care CPT codes across states to examine the current national landscape of reimbursement. The mean adjusted reimbursed rates across eight integrated behavioral health CPT codes were more similar within states than across states, leading to a hypothesis that pricing based on resource use cannot be explained by the Centers for Medicare and Medicaid Services’ federal pricing mechanism.
Lastly, researchers developed a typology to organize integrated care types by affiliate institution, location, and care type. Three IBH general care categories were identified: (1) behavioral health specialist and primary care provider employed within the same department and institution, (2) behavioral health specialist and primary care provider employed in different departments in the same institution, and (3) behavioral health specialist and primary care provider employed by different institutions.
This study identifies possible inefficiencies in paying differently for similar services by examining the variations in procedure codes and fees paid by government payers across states for the incremental integrated care services. Policymakers designing reimbursement for IBH should consider how variation in financing influences how providers submit different CPT codes that may be used for similar integrated care services. Additionally, state and federal regulators are advised to recognize the inefficiencies in the market and in health systems from potential rate manipulation and economic policy incentives.