Treating behavioral health and physical health separately has resulted in poorer outcomes, higher costs and fragmentation at almost all levels in health care. Scientific evidence shows it doesn't make sense to proceed as if the brain and behavior are separate from the body. That's why there are numerous efforts underway to promote "integrated primary care services" in Colorado and elsewhere.
In short, integrated primary care is a model of health care delivery that engages individuals and their caregivers in the full range of physical, psychological, social, preventive and therapeutic factors necessary for a healthy life. Yet, while integrated primary care services improve patient health and provider morale, many providers have encountered difficulties implementing the model due to reimbursement constraints and the complex nature of billing health plans.
Recognizing that most programs that integrate physical and behavioral health struggle with financial sustainability, the Colorado Health Foundation partnered with the Collaborative Family Healthcare Association (or CFHA) to launch the Promoting Integrated Care Sustainability (or PICS) project. PICS is a statewide effort that aims to identify the financial barriers to integrating physical health and behavioral health care services and to implement Colorado-specific solutions to move integrated primary care into the mainstream of health care.
The PICS team surveyed clinics and practices across Colorado that integrated behavioral health into a primary care setting or primary care into a behavioral health setting. By conducting interviews with providers who integrated behavioral and physical health care in other states, PICS developed preliminary policy recommendations and considered "next steps" to support financially sustaining integrated care services across Colorado. The analysis of the PICS project findings will be finalized and shared later this year, but the preliminary data tell us that integrated care services in Colorado are primarily grant funded. On average, those who provided integrated care recouped only 20 percent of the costs associated with the services. In fact, many integrated care services simply are not reimbursable by today's standards.
On Nov. 7, PICS released preliminary policy recommendations at a summit convened by the Foundation and CFHA. The recommendations are intended to help providers generate some revenue from integrated care in the short term. In the long term, the tactics aim to gather robust cost data and move the health care system away from a fee-for-service, volume-based, payment structure towards more global payment strategies. Here are the recommendations:
- Clarify current billing regulations and train integrated care sites to optimize the use of existing revenue sources to provide cost efficient, medically necessary care.
- Resolve confusion about the ability of behavioral health and physical health providers to bill for services provided to the same patient on the same day and pursue efforts to reduce administrative barriers.
- Examine the viability of health plan payment for health and behavior assessment codes to provide health behavior services for self-management of chronic illness.
- Test and analyze the viability of global funding strategies, defined by a single or enhanced payment for all care received, to financially sustain integrated care services.
- Plan and implement a standardized statewide data collection system to document financial, operational and clinical outcomes and costs of integrated care services.
These are exciting times in health care. However, many challenges still lie ahead for integrated primary care services. To keep fragmentation from prevailing, we must build upon the many collaborative and innovative health care efforts in Colorado and across the country to support appropriate payment for integrated care services. Let's hope these preliminary recommendations will provide a good starting point for accomplishing that important goal for Colorado's health care system.
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