Overcoming roadblocks: Current and emerging reimbursement strategies for integrated mental health services in primary care

Allison N. O'Donnell, Mark D Williams, Amy M. Kilbourne

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Original languageEnglish (US)
Pages (from-to)1667-1672
Number of pages6
JournalJournal of General Internal Medicine
Volume28
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Mental Health Services
Primary Health Care
Mental Health
Delivery of Health Care
Fee-for-Service Plans
Patient-Centered Care
Health Care Reform
Mental Disorders
Psychiatry
Referral and Consultation
Guidelines
Therapeutics

Keywords

  • chronic care model
  • health care financing
  • mental disorders

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Overcoming roadblocks : Current and emerging reimbursement strategies for integrated mental health services in primary care. / O'Donnell, Allison N.; Williams, Mark D; Kilbourne, Amy M.

In: Journal of General Internal Medicine, Vol. 28, No. 12, 12.2013, p. 1667-1672.

Research output: Contribution to journalArticle

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