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Collaborative Care Education and Resource Guide

As of October 1, 2018, North Carolina primary care practices that provide collaborative care services can now bill Medicaid using the Psychiatric collaborative care management services codes (99492, 99493, 99494). 

This team-based care approach focuses on a new way to leverage psychiatrists and provide evidence-based management of behavioral health conditions in the primary care setting. In addition to improving access, clinical outcomes, and patient satisfaction, the Collaborative Care Model (CoCM) has also shown a return on investment (ROI) of 6:1. The CoCM’s ability to help manage Medicaid costs for behavioral health conditions and complement the state’s approach to whole-person care (as outlined in the recent Medicaid Request for Proposal for managed care) make it an excellent option for North Carolina.

To date, the American Psychiatric Association’s (APA) Support and Alignment Network (SAN), part of CMS’ Transforming Clinical Practice Initiative (TCPi), has trained over 150 North Carolina clinicians (127 psychiatrists; 29 primary care physicians) in collaborative care.

The American Psychiatric Association is a Support and Alignment Network (SAN) as part of CMS’ Transforming Clinical Practice Initiative (TCPI). Through TCPI, the APA is training a workforce of psychiatrists in the Collaborative Care Model (CoCM) and is ready to work with primary care practices to improve patient outcomes and increase access. The APA is working to educate its members on Collaborative Care, provide technical assistance in the changing practice environment, develop and disseminate best practices and resources on Collaborative Care, and develop and advocate for equitable reimbursement models.

What is the Collaborative Care Model (CoCM)

The Collaborative Care Model (CoCM) uses a team-based, interdisciplinary approach to deliver evidence-based diagnoses, treatment, and follow-up care to an identified patient population.  It is being embraced and adopted in several health-care systems across the state. Not only does it provide evidence-based care of mental illness and substance use disorders, it is documented to improve access, clinical outcomes, and patient satisfaction. 

Many primary care physicians (PCPs) have raised concerns about the move to uniformly screen all their patients for psychiatric conditions, citing their inability to make timely referrals when patients screen positive.  CoCM gives a next step for PCPs to clinically address care for these patients.

In the CoCM, practices set up a disorder-specific registry of patients within the practice who have been identified with mental illness or a co-occurring disorder who are not improving under routine primary care.  The Behavioral Health Care Manager (BHCM) is employed by the primary care practice and puts in place scheduled screenings, evaluations, and follow-up calls for each patient on the registry.  The BHCM also meets weekly (in person or by phone) with the consulting psychiatrist to review the charts and discuss the patients on the registry, determining whether progress is being made toward the treatment goals or if other interventions/changes in medications need to be recommended.  The care manager, if a licensed mental health professional, may provide some short-term therapy in some cases.  The consulting psychiatrist rarely, if ever, sees a patient, but instead reviews charts, looks at progress, and makes recommendations to the PCP through the BHCM.

Psychiatrists and the BHCM do not bill for these codes.  Only the PCP can bill, but the bundled payments support the employment of the BHCM and the contracted hours with the psychiatrist. Learn More

 

 

What are the Benefits of CoCM?

There are many benefits of the CoCM for psychiatrists, primary care practices and patients. 

Psychiatrists are uniquely positioned to be able to provide consultation under this model. Many psychiatrists contract out a day or two a week to agencies and clinics.  The flexibility of this model allows for similar scheduling with a primary care practice.  There is no insurance billing or bill collections.  Psychiatrists contract their hours with the practice.

Extends the reach of psychiatric oversight.  Psychiatrists are limited by the number of hours in a day and the number of patients they can see in an hour.  Managing a registry of 60 patients and providing weekly chart review, overseeing medications and therapeutic interventions, and making clinical recommendations geometrically multiplies the number of patients who benefit from a psychiatrists’ specialized training.  

Trains PCPs in mental health and psychiatrists in population health. As psychiatrists in the model make clinical recommendations to the PCP, the primary care physicians become more accustomed to informed clinical interventions and more confident in treating patients with psychiatric disorders in their practices.  Similarly, instead of treating each patient individually, a psychiatrist benefits from the experience of “treating to target” in a population health approach.

CoCM impacts costs.  National research has shown that the CoCM offers a 6:1 return on the financial investment.  By adopting this model, NC Medicaid can help manage Medicaid costs for mental illness and substance use conditions while complementing the state’s approach to whole-person care.

Most importantly, patients get better.  In more than 80 randomized controlled clinical studies, CoCM has been shown to lead to better patient outcomes, better patient and provider satisfaction, improved functioning, and reductions in healthcare costs.  In a world where 50% of patients who receive referrals for specialty mental health care never follow through, improved treatment in a primary care practice under the care of the CoCM team is a big win.

CoCM Training & Educational Opportunities >>

Implementing the Collaborative Care Model >>

Reimbursement for Collaborative Care >>

The Collaborative Care Model: The Role of the Psychiatrist 

 

Additional Resources

Economic Impact Reports

 

APA Member Resources

PsychPRO – Qualified Clinical Data Registry (QCDR): PsychPRO is APA’s CMS Qualified Clinical Data Registry (QCDR) that helps psychiatrists deliver high quality care and meet new MACRA quality reporting requirements by the Centers for Medicare and Medicaid Services (CMS).  The clinical registry helps providers easily collect and submit quality reports – and gives patients a secure way to provide information to their clinicians to track their progress
Practice Management Helpline: APA’s Practice Management Helpline is available Monday – Friday. 8:30AM – 4:30PM (EST), this service is provided to APA members needing assistance with a wide variety of practice management issues, including:
  • Reimbursement
  • Contracting with managed care companies
  • Coding
  • Documentation
  • Medicare
  • Medicaid
  • Starting a practice
  • Closing a practice