TY - JOUR
T1 - Overcoming roadblocks
T2 - Current and emerging reimbursement strategies for integrated mental health services in primary care
AU - O'Donnell, Allison N.
AU - Williams, Mark
AU - Kilbourne, Amy M.
N1 - Funding Information:
Acknowledgements: This research was supported by the National Institutes of Health (R01 MH79994) and the Department of Veterans Affairs, Veterans Health Administration, Health Service Research and Development Service (IIR 10–340). The views expressed in this article are those of the authors and do not necessarily represent the views of the VA. We would also like to acknowledge Daniel Eisenberg, PhD, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, for providing helpful feedback on earlier drafts of this manuscript.
PY - 2013/12
Y1 - 2013/12
N2 - The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.
AB - The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.
KW - chronic care model
KW - health care financing
KW - mental disorders
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U2 - 10.1007/s11606-013-2496-z
DO - 10.1007/s11606-013-2496-z
M3 - Review article
C2 - 23733375
AN - SCOPUS:84890442739
SN - 0884-8734
VL - 28
SP - 1667
EP - 1672
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 12
ER -