The Collaborative Care Model (CoCM) that provides team treatment for mental health patients has been shown to increase access to mental health care, save money and improve outcomes. That is why sponsors are promoting Senate Bill 178, which would require all payers, including Medicaid, to reimburse for CoCM.
Patty Gibson, MD, president-elect of Arkansas Psychiatric Society, said CoCM adds a behavioral health care manager and psychiatric consultant to support primary care providers (PCPs), pediatricians and OB-GYN clinicians. After doing an evaluation, the CoCM team provides recommendations back to the primary clinician related to medications or other treatments.
Under the supervision of the PCP and consulting psychiatrist, the care manager continues to meet with the patient in person, by telephone or televideo to monitor their response to treatment with medications, behavioral interventions and coping strategies. The care manager reports back to the referring physicians and makes other referrals if the patient does not improve.
CoCM is currently being reimbursed by Medicare and commercial insurance companies like Blue Cross and Blue Shield. They have found that this investment not only improves mental health outcomes but also saves money overall. Research has shown that for every $1 spent on CoCM, there is a $6 savings in overall healthcare costs, mostly because of the decreased need for inpatient care for physical health problems.
Gibson said the program is particularly needed now because of the shortage of mental health providers at a time when there are increased rates of depression, anxiety, suicide and drug overdoses—some of which are linked to the continuing fallout from the pandemic.
“CoCM increases access to mental health treatment,” Gibson said. “We know there are not enough psychiatrists and counselors in Arkansas so primary care is the de facto mental health system, and they prescribe 75 percent of psychotropic medications. Even before the pandemic when physicians referred patients to mental health providers, only 20 percent of patients actually made it to the first appointment. Of those 20 percent, 10 percent didn’t go back for a second visit.”
Gibson said that, unfortunately, these primary care clinicians don’t get enough training to handle patients with complex mental health issues. Having integrated behavioral health and having CoCM available helps the PCPs provide better care to their patients.
There are many barriers to mental health care, including stigma, long wait times, difficulty getting an appointment, insurance coverage and inconvenience. That is why most people get mental health treatment from their family physicians, pediatricians and OB-GYNs.
“Increasing access to mental health care is also important to employers and the economy because depression, anxiety and other mental health issues increase absenteeism, presenteeism and disability,” Gibson said. “Providing access to mental health care, including CoCM is the right thing to do to improve overall health, quality of life and function of Arkansans.”
For more information, see the Journal of Arkansas Medical Society and this article from the AIMS Center.
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