Collaborative Care Model

Issue:
In our current healthcare system, the treatment of medical illness and behavioral health conditions, including mental health and substance use disorders, are treated as discrete problems as though they were not occurring in the same person. While mental illness should be treated in conjunction with other medical conditions, it is left undetected and untreated most of the time by medical providers who increasingly have little time to manage complex medical problems. There is also a scarcity of mental health resources and psychiatrists making access to behavioral health care difficult. Consequently, untreated mental illness takes an enormous toll on individuals and our healthcare system including exacerbations of underlying medical conditions, increased mortality and excessive consumption of healthcare resources leading to substantially increased costs. Consider the following:

1. 77.5 million people in the US – 26% of adults and 21% of children – have a diagnosable mental or substance use disorder in a given year. Of these individuals, only 38% of adults and 20% of children receive needed behavioral health care.
2. Medical costs for treating patients with mental health/substance use disorders are 2 to 3 times higher than for those who do not have them. These additional healthcare costs total $293 billion annually.
3. While only 14% of insured individuals receive treatment for a mental health/substance use disorder, they account for more than 30% of total healthcare spending.
4. 60% of those with mental illness and 90% of those with a substance use disorder do not receive behavioral health treatment in a given year.
5. In primary care, mental illness is left undetected more than 50% of the time and when it is diagnosed, the vast majority of these individuals do not get better.
6. A major challenge of COVID 19 has been the surge of behavioral health crises flooding primary care practices which already have limited resources to manage these problems.

Enhancing health care quality, access and value, including psychiatric services, requires employing a new model of care with organized, proactive approaches to individuals’ and populations’ health.

It is the position of the NJPA that:
In the Primary Care setting, the NJPA recognizes a model of integrated care known as the Collaborative Care Model (CoCM) as the most effective approach with demonstrated positive outcomes and cost containment across different mental health diagnoses and treatment locations. This model enables enhanced access to the available psychiatric workforce to provide improved care outside the traditional psychiatric settings. CoCM offers a team-based approach and includes primary care providers, behavioral health care managers (BHCM) and psychiatric consultants attentive to psychosocial needs, cultural differences and healthcare equity. The primary care provider prescribes psychiatric medication with support and consultation from the BHCM and consulting psychiatrist. The consulting psychiatrist, who does not see patients directly, will provide caseload consultation to the BHCM for several hours each week thereby leveraging psychiatric support among a large number of patients. CoCM is population-focused with universal screenings for targeted psychiatric illness, measurement-guided to ensure that all patients get better and an accountable model of care where outcomes are closely tracked in a registry with no patient falling through the cracks. With over 100 randomized control studies, CoCM is evidence based resulting in demonstrably improved outcomes for the vast majority of patients.

The Collaborative Care Model results in the following:

1. Universal screening upon entry into the primary care practice or at the annual wellness visit for all patients.
2. The majority of patients with mental illnesses such as depression and anxiety are identified, receive appropriate care, get better and remain well.
3. The health of our communities will improve and the vicious cycle of behavioral health problems exacerbating medical disorders leading to excessive utilization and healthcare costs will stop.
4. For every $1 invested in a Collaborative Care Model there is a savings of $6.50. Most of those savings are due to a decrease in excessive consumption of healthcare resources.
5. If Collaborative Care Models were implemented in primary care practices throughout the US, there would be an annual savings of $26-$48 billion dollars.

The NJPA recommends all insurance carriers and NJ Medicaid provide reimbursement for CoCM CPT codes. These CPT codes are billed by primary care physicians and cover the cost of behavioral care services provided by behavioral health care managers and psychiatric consultants integrated in primary care practices.