Collaborative Behavioral Care Resources

Collaborative behavioral care, aka integrated care, portends a fundamental change in the way behavioral healthcare is delivered in the US. Because of user interest, CarePaths is working on other products and features to support this area of practice.

This bibliography, put together by Eric Berko, Ph.D. who is a specialist in collaborative care and a CarePaths user, includes two comprehensive websites that have multiple links to resources ranging from basic definitions to the skills needed for successful practice to measurement and implementation. There is also position paper from the Millbank Foundation and four book references that can help with implementation.

WEBSITES WITH MULTIPLE LINKS
(EVALUATION, PRACTICE MANAGEMENT, LEVELS OF INTEGRATION, IMPLEMENTATION)

1) SAMHSA Integrated Care Website: Evidence, examples, and models supporting primary and behavioral healthcare integration.
http://www.integration.samhsa.gov/integrated-care-models
Website with a continuum of models of integrated care. There are links to quick start suggestions, including ways to financially support behavioral health providers into a medical setting.

2) AHRQ Agency for Healthcare Research and Quality
https://integrationacademy.ahrq.gov/
U.S Department of Health and Human Services website that includes resources for research and practice of Behavioral Health Integration. Has an interactive list of measures for research as well as practice evaluation. Information includes ethical, legal and financial issues.

POSITION PAPER ONLINE
Integrating Primary Care into Behavioral Health Settings: What Works for Individuals with Serious Mental Illness by Martha Gerrity, MD, MPH, PhD
http://www.milbank.org/uploads/documents/papers/Integrating-Primary-Care-Report.pdf
A summary of “reverse co-location”. It explains the need for holistic mental health and primary care provision. Models of integration and practice implementation recommendations are included

BOOKS
Behavioral Integrative Care; Treatments That Work in the Primary Care Setting. O’Donohue, W.T., Byrd, M.R., Cummings, N.A., Henderson D.A., Routledge. 2005
Integrated Behavioral Health in Primary Care: Step-By-Step Guidance for Assessment and Intervention. Hunter, C.L.. American Psychological Association. 2009.
Integrating Behavioral Health in Primary Care: Evaluating the Evidence, Identifying the Essentials. Talen, M.R. & Valeras, A.B., Springer Science and Business Media. 2013
Integrated Primary and Behavioral Care; Role in Medical Homes and Chronic Disease Self Management. O’Donohue, Maragakis. Springer. 2015.

Out of Pocket expenses for behavioral healthcare continue to rise

Insurers are shifting costs to patients and decreasing insurance reimbursement, making it harder for patients to afford mental health care and harder for therapists to make a living.

Health care out of pocket expenses (OOP) increased substantially in 2016 and behavioral health care did not buck that trend. OOP are all expenses borne by the patient be they co-payments, co-insurance costs, deductible costs or any other cost sharing arrangement.

This chart shows the increase in patient OOP as a percent of total reimbursement for all payers(BCBS, commercial, medicare and medicaid). Note psychiatric E&M codes rose along with therapist codes:
all payer patient share

The next chart shows the same trend applies to BCBS and commercial payers:
bc and com patient change

This chart shows that the trend among all payers is to increase patient responsibility, decrease insurance reimbursement while maintaining the allowable:
reimbursement changes all payers

This trend is also reflected in BCBS and commercial payer data:
reimbursement changes bc & com

Patient responsibility has increased more for some CPT codes than others. For all payers, the most common CPT code 90834 increased 18.1% between 2015 and 2016; for intakes, 90791, the increase was 26.5%.
all payer table

For BCBS code 90834 patient responsibility increased 16.1% between 2015 and 2016; for intakes, 90791, the increase was was 17.2%.
bc & com table