Behavioral health continues to top the list of issues that plague the health of so many elderly Americans, and the added complexity of a global pandemic further complicates this issue. But as the number of lives impacted by behavioral health continues to rise, the harsh reality is that most adults impacted by these types of conditions do not receive help. Due to lack of resources or the stigma around receiving assistance, many patients are reluctant to discuss behavioral health with their primary care providers; only 1 out of every 3 adults ever receives help. When these conditions go untreated, they significantly impact patients’ physical well-being. Depression is the most common behavioral health condition in the elderly, and it is rarely experienced alone. Unfortunately, depression and many other behavioral conditions go hand in hand with diabetes, heart disease, chronic pain, cancer, neurological disorders, and other geriatric syndromes.
Even with significant research showing that treatment of mental health conditions can have an astoundingly positive impact on individuals’ overall health, utilization of behavioral health integration (BHI) has remained relatively low in primary care offices. Up until 2017, primary care settings did not have a clear financial motivation to integrate these types of services into their practice. However, in January 2017, the Centers for Medicaid and Medicare Services (CMS) made four new billing codes available through the Medicare Physician Fee Schedule to enhance primary care with behavioral health-focused care management:
Psychiatric Collaborative Care Model (CoCM): 99492, 99493, 99494
General Behavioral Health Integration: 99484
While CoCM has many service components, including psychiatric consultation through a medically trained professional (one who is qualified to prescribe the full range of medication), the general BHI CPT code can be used to bill directly from the primary care provider without the need of a psychiatric professional. General BHI services include:
- Systematic assessments and monitoring using validated rating scales such as the PHQ-9
- Coordination of treatment related to behavioral health
- Behavioral care planning and revisions
General BHI services focus on screening and identification for early intervention of behavioral health issues. Through active screening and identification, primary care providers can use care management teams to track and monitor progress of patients when they are away from the office to identify declines in behavioral health status. Within these services, care managers can also provide health coaching and education to better manage conditions while identifying at risk patients that need immediate assistance prior to the need for acute escalation.
The Quadruple AIM
By integrating behavioral health into primary care, behavioral health becomes more accessible to many more individuals. It specifically benefits Medicare beneficiaries, the population most at risk with the least access to behavioral health care. The integrated model further advances the quadruple aim of healthcare by upgrading care delivery:
1. Improved population health
Even though many Medicare beneficiaries are impacted by conditions such as depression, anxiety, or substance abuse, more than two-thirds receive help. Behavioral health focused care management helps to identify patients through expanded screening and address their conditions in real time, which has a widespread positive impact on population health.
2. Improved provider satisfaction
When care managers regularly engage with patients, they can give providers access to patient’s progress between office visits. With this information, providers can spend their limited face to face time with patients appropriately addressing the issues that continue to affect their health rather than figuring out medical history. This can significantly and effectively reduce provider burnout and improve job satisfaction.
3. Improved experience of care
By recognizing that mental health conditions and addictions are genuine medical conditions, patients get an integrated care experience. This holistic healthcare approach focuses on a full assessment of patients’ needs thereby greatly improving experience of care.
4. Bending the cost curve
when a decline in behavioral health status is identified, we are able to avoid higher cost stays in hospitals and emergency rooms, thus drastically reducing healthcare expenditures.
Unfortunately, medical, mental health and addiction exist in separate silos that create fragmented care which do not address patients’ challenges related to both physical and mental well-being. By making improvements on behavioral healthcare access, primary care providers can break down the silos to address the challenges patients face while taking advantage of new revenue opportunities.
References:
The National Council. (2018). The Value of Integrated Behavioral Health [Presentation]. Retrieved from
https://www.thenationalcouncil.org/wp-content/uploads/2018/10/The_Value_of_Integrated_Behavioral_Health_09.07.18.pdf?daf=375ateTbd56
The New England Journal Medicine. (2017, 07 February ). Medicare Payment for Behavioral Health Integration. [Weblog]. Retrieved from
https://www.nejm.org/doi/full/10.1056/NEJMp1614134?query=psychiatry
The Aims Center. (2019). Cheat Sheet on Medicare Payments for Behavioral Health Integration Services. Retrieved from
https://aims.uw.edu/sites/default/files/CMS_FinalRule_BHI_CheatSheet.pdf#:~:text=Medicare%20pays%20for%20services%20provided%20to%