Lessons from the Field: How Health First is Implementing Collaborative Care

A growing number of provider organizations are eager to implement a patient-centric care model known as the psychiatric collaborative care model (CoCM). According to John Eiler, System VP of Behavioral Services at Health First, the reasons why are clear: the model delivers on its promise to cost-effectively improve patient outcomes especially when it comes to chronic disease management.

CoCM supports patients with personalized treatment teams that include a primary care provider (PCP), a behavioral health care manager, and a psychiatric consultant. By surrounding patients with a team of both physical and behavioral health specialists, CoCM enables a holistic and preventive approach to care.

NeuroFlow CEO Chris Molaro recently sat down with Eiler to discuss the recently launched CoCM program at Health First. Here are five takeaways from their conversation:

1. Integrated health benefits both patients and providers.

While CoCM connects patients with behavioral health care managers and psychiatric consultants, it makes the most sense for PCPs to head the care team largely because these are the clinicians patients trust most. Likewise, because initial conversations about behavioral health tend to occur during visits with a trusted PCP, CoCM eliminates many of the stigmas around mental health. 

CoCM also empowers PCPs to deliver better care without additional time and administrative burdens. At Health First, that’s achieved in part due to the integration of the NeuroFlow application with the athenahealth EHR. It allows PCPs to remain part of the care team after a warm hand-off to behavioral health providers.

So far, roughly 44% of the patients approached about participating in Health First’s recently launched CoCM program have enrolled. Within the first eight weeks, 319 patients were referred to behavioral health providers through the organization’s CoCM platform.

2. CoCM is well-studied and evidence-based.

CoCM is not a new or untested care model. Over the past several decades, more than eighty peer-reviewed studies have proven its effectiveness. Validated by the University of Washington AIMS Center, the American Psychiatric Association, and others, CoCM, past and present, focuses on evidence-based care and measurement-based treatment.

“It’s very much an evidence-based treatment. We are looking for clearly defined gains in reduction of symptoms as measured by anxiety measures like the GAD-7…”  – John Eiler

3. CoCM delivers economic benefits for health systems and payers.

Under fee-for-service contracts, certain billing codes give PCPs a reimbursement mechanism for CoCM services. Furthermore, by using NeuroFlow to help physicians capture the most precise behavioral health ICD-10-CM codes, Eiler expects to see reimbursements rise. Coding diagnoses to the highest specificity (think “recurrent depression” vs. “depression, unspecified”) should lead to more accurate HCC coding, which Eiler hopes will result in a $1.5 million reimbursement increase for his organization in the first year from CMS alone. 

But perhaps the most significant impact of CoCM for patients, health systems, and payers comes from the positive influence—and associated cost savings—of behavioral health on chronic conditions. Most major payers encourage CoCM because of its huge benefit, not just to behavioral health, but also to managing chronic diseases.

4. Co-locating care team professionals instead of CoCM is not likely to achieve the same results—and comes with its own set of challenges

CoCM requires “detail” management such as tracking and documenting minutes of service for reimbursement, leaving some health systems asking the question, “Why not just co-locate behavioral health providers and PCPs?”

From his experience, Eiler urges health systems to remember that most payers carve out mental health services—making it difficult to get providers paneled. On the other hand, CoCM billing is done through the PCP, which avoids the hassle of dealing with payers’ behavioral health carve-outs, third-party administrators, and other administrative obstacles. 

In addition, while co-location puts behavioral health providers near PCPs, it doesn’t necessarily ensure a cohesive care team approach. CoCM enabled through technology platforms such as NeuroFlow gives all providers a true 360-degree view of the patient.

5. Technology adoption is a must

Eiler notes that many providers try to achieve CoCM with paper-and-pencil, but workflow optimization is everything in a busy PCP office. Getting off-schedule by fifteen minutes often destroys an entire day. To be effective, CoCM can’t disrupt PCPs’ workflows.

Moreover, Eiler recognizes that it’s unrealistic for patients to fill out behavioral health assessment tools on paper in the waiting room and then expect front desk staff to score and enter the data into the EHR in time for the PCP to use the information during the patient visit. NeuroFlow automates that process and more for Health First with behavioral health risk identification, patient intake, and proactive enrollee outreach. 

CoCM is a well-studied and patient-centric care model that promises substantive benefits for the providers who leverage technology to embrace it. To discover more, visit https://www.neuroflow.com/psychiatric-collaborative-care/

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