Financing for Collaborative Care—a Narrative Review
Purpose of review
Collaborative care (CoCM) is an evidence-based model for the treatment of common mental health conditions in the primary care setting. Its workflow encourages systematic communication among clinicians outside of face-to-face patient encounters, which has posed financial challenges in traditional fee-for-service reimbursement environments.
Organizations have employed various financing strategies to promote CoCM sustainability, including external grants, alternate payment model contracts with specific payers, and the use of billing codes for individual components of CoCM. In recent years, Medicare approved fee-for-service, time-based billing codes for CoCM that allow for the reimbursement of patient care performed outside of face-to-face encounters. A growing number of Medicaid and commercial payers have followed suit, either recognizing the fee-for-service codes or contracting to reimburse in alternate payment models.
Although significant challenges remain, novel methods for payment and cooperative efforts among insurers have helped move CoCM closer to financial sustainability.
KeywordsCollaborative care Healthcare financing Health service reimbursement Financial sustainability Health policy
Dr. Carlo was supported by a post-doctoral fellowship from the National Institute of Mental Health (T32 MH20021 Psychiatry–Primary Care Psychiatry Fellowship Program Training Grant).
Compliance with Ethical Standards
Conflict of Interest
Dr. Ratzliff reports personal fees and being a spouse employee from Allergan, grants, personal fees, and being a Subcontractor for APA-San and a National Faculty Role from CMS Transforming Clinical Practices Initiative, royalties paid to department from Wiley, training and technical assistance from Community Health Plan of Washington, grants and training and technical assistance from HRSA-NIMH, and training and technical assistance from Washington State Integrated Care Training Program, outside the submitted work.
Andrew D. Carlo, Jürgen Unützer, and Joseph M. Cerimele declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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