Integrated Care

Over the past decade, the integration of behavioral health and general medical services has been shown to improve patient outcomes, save money, and reduce stigma related to mental health. Significant research spanning three decades has identified one model – the Collaborative Care Model – in particular, as being effective and efficient in delivering integrated care.

APA's Milliman Report

CMS Payments for Integrated Behavioral Health Services

Integrated care models have generated a great deal of interest and promise for the treatment of mild to moderate mental health conditions in the primary care setting. In North Carolina, integrated care programs have often relied on the "co-location" model of care, where a behavioral care provider is in the same physical location as the primary care provider but is not integrated into the model of care. Few integrated care programs have demonstrated a high level of fidelity to evidence-based models of integrated care; low fidelity has weakened the efficacy and the return on investment (ROI) in terms of improved patient outcomes and cost savings seen in evidence-based models of integration.

Starting in January 2017, the Centers for Medicare and Medicaid Services (CMS) approved payment for services provided to patients with behavioral health disorders who are participating in psychiatric collaborative care programs or are receiving behavioral health integration services. CMS has classified this group of services as “Behavioral Health Integration” (BHI) services, and it includes three codes describing Psychiatric Collaborative Care Management services (99492, 99493, 99494) and General BHI service (99484). Coverage for these services includes patients with a behavioral health or substance use disorder who receive coverage through a traditional Medicare plan or Medicare Advantage plan. These services can be billed in both non-facility and facility settings; however, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (FHCs) cannot currently bill these services. 

99492 (formerly G0502) - First 70 minutes in the first calendar month for behavioral health care manager activities in consultation with a psychiatric consultant and directed by the treating primary care provider.

99493 (formerly G0503) - First 60 minutes in a subsequent month of behavioral health care manager activities.

99494 (formerly G0504) - Each additional 30 minutes in a calendar month of behavioral health care manager activities.

The University of Washington's AIMS Center has developed a Cheat Sheet on the CMS Final Rule for 2017.

Collaborative Care Resources

Online Training for Psychiatrists

Online Training for Primary Care Physicians

Models in Practice

Liability Issues

Evidence-Based Policy Support

Communication Resources

General Resources

Coding & Billing Support

Accountable Care Guide for Psychiatrists 

The NC Psychiatric Association and the Toward Accountable Care (TAC) Consortium and Initiative is pleased to present a specialty toolkit for those physicians interested in learning more about how their practice fits into the value-based model called an accountable care organization (ACO).

Accountable Care Guide for Psychiatrists was released on December 19, 2013. This is the fourth published by TAC as part of its mission to provide the medical community with the knowledge and tools needed to understand, participate in, navigate, lead, and succeed in a value-driven healthcare system. This and the other toolkits published thus far are available free of cost on the TAC website. In addition to the specialty-specific resources, there is also a legal guide and a guide to shared savings distribution.

There are 39 healthcare organizations participating in the TAC. See the list on the TAC website. The TAC has just released the Physicians CIN and ACO Contracting Guide, designed to help physicians considering joining a clinical integrated network (CIN) or Accountable Care Organization (ACO).

To learn more about this seminal organization and its work, as well as timely features and news about the emerging ACO model of care, click here.