Integrating primary care and mental health care – The Boston Globe

The ability to find a behavioral health practitioner, especially one who can address a patient’s particular needs and who accepts insurance, has long been a challenge, a challenge made worse by the COVID-19 pandemic. Because of the stigma and practical barriers, many people don’t bother trying. According to the Blue Cross Blue Shield Foundation of Massachusetts, in a survey conducted from December 2020 to March 2021, 57 percent of Massachusetts adults who reported needing behavioral health care had difficulty getting appointments for care when needed or did not get behavioral health care at all. .

The collaborative care model involves team-based care, combining primary care providers and behavioral health physicians in a primary care office. In years of studies, the model has proven to be effective in treating depression and anxiety. It is also cost-effective, as it favors early intervention. North Carolina officials are so enamored with the model that the state is offering doctors technical assistance to implement it, in addition to providing high Medicaid reimbursement rates.

In 2017, the Centers for Medicare and Medicaid Services approved billing codes that allow practices to bill insurance for collaborative care. MassHealth began using the codes in 2018, and by 2022, Massachusetts law required reimbursement from private insurers.

Transforming the practice of medicine is never simple, but resources are available to help physicians implement collaborative care. More physician practices should make this leap.

Wayne Altman, an Arlington physician who founded a physician alliance dedicated to improving primary care, began using collaborative care in January. She said it feels luxurious and indulgent to easily refer patients to mental health care and work with physicians in her practice. But it feels that way because they were so used to the scarcity of mental health resources, Altman said. People are used to mental health care being inaccessible and expensive.

When a patient comes into Altmans’ office with a mental health problem, he can refer them to an in-house care manager and therapist. While the therapist provides short-term clinical therapy, the care manager does everything else: talking with patients to understand their concerns, coordinating with community resources, following up with patients, and offering nonclinical advice. The care team consults with a psychiatrist, who can recommend or adjust the medication, which is prescribed by the primary care doctor. Results are tracked in a database.

At the Altmans’ practice, behavioral health clinicians are employed by the Brookline Center for Community Mental Healths Innovation Institute, with funding from the philanthropic foundation Accelerate the Future. But the model is expected to become self-sustaining through insurance reimbursement. (Because Change Healthcare’s data breach delayed insurance reimbursements, financial data is not yet available.)

Collaborative care opens up new financial opportunities. Traditionally, a therapy session or primary care appointment is reimbursable, but time spent by physicians making follow-up phone calls or coordinating with another medical provider is not. New codes refund this time. At the same time, studies have shown that overall healthcare costs are lower with collaborative care because early treatment prevents more serious medical problems.

Collaborative care can also address workforce burnout because a care manager, a position that only requires a bachelor’s degree, can perform nonclinical activities that would otherwise fall to a physician of primary care or a master’s degree therapist. A consultant psychiatrist who meets with the care team can advise on the treatment of a group of patients more efficiently than if they treated each patient individually.

Most importantly, countless studies show that the model works to improve symptoms, especially in patients with moderate to mild depression and anxiety, although it has been used for other illnesses. This is probably one of the most evidence-based approaches to providing mental health services in medical settings, particularly primary care, said Anna Ratzliff, co-director of the AIMS Center at the University of Washington School of Medicine, which focuses on integrating mental and physical health. cure

An example is Aloft Integrated Wellness in Exeter, NH, which pioneered the use of collaborative care for pediatrics in 2020. It hired two master’s level therapists, a care manager at high school and a consultant child psychiatrist based in Colorado. In 2.5 years, coinciding with the COVID-19 pandemic, 550 patients were treated and only one went to the emergency department for behavioral health needs, according to Alofts data. According to Aloft, patients can schedule appointments within two weeks and can receive short-term therapy. Screening tools ensure that treatments work.

Aloft co-founder Jessica Lyons said the care manager performs tasks as diverse as meeting with school counselors, helping families address food insecurity and instructing patients on sleep hygiene. Although the practice opened with grant money, Lyons said it has become financially sustainable.

Implementing collaborative care takes effort. Providers have to bill differently, and there are upfront costs to hire doctors and build a patient database.

Different practices are experimenting with different models. Although federal billing codes require a case manager, physician, and psychiatric consultant, some practices add other staff, such as master’s level therapists. Brigham General is testing a model in which primary care physicians refer patients to remote clinical social workers employed by Concert Health for psychotherapy. Ratzliff said collaborative care has been tested in specialties such as obstetrics and cancer care.

It will take trial and error to find out how the model works best. But evidence suggests that, when done well, collaborative care improves the quality of health care while reducing costs and allowing doctors to focus on what they are trained to do. These are goals worth pursuing.

Editorials represent the views of the Boston Globe Editorial Board. follow us @GlobeOpinion.