Psychiatric Collaborative Care Management Services” are designed to improve care for the majority of patients who receive treatment for mental health and substance use disorders through their primary care provider. These services are based upon the “Collaborative Care Model” (CoCM) developed by the late Wayne Katon, M.D. and Jurgen Unitzer, M.D., at the AIMS Center of the University of Washington. This is the only evidence-based model of its kind and was proven effective in more than 80 randomized control trials.
Under these services (and the CoCM), the primary health care provider employs a behavioral health care manager to provide ongoing care management for a caseload of patients with diagnosed mental health or substance use disorders. A consulting psychiatrist provides the primary care practice with the benefit of his or her specialized expertise in treating such conditions, through regular case review and recommendations for treatment, medication adjustments, the need for specialty care, etc.
As you know, APA received a grant from CMS through its Transforming Clinical Practice Initiative to train psychiatrists and PCPs in the CoCM and to encourage systems to implement this evidence-based model. Having payment for these services will only strengthen this initiative. For more information about the TCPI, visit www.psych.org/SAN.
This win was an APA lead effort by our Policy Reimbursement team – Becky Yowell, Eileen Carlson, and Sam Muszynski – Jurgen Unitzer, M.D., and Jeremy Musher, M.D ., APA CPT and RUC advisor. This could not have happened without our leaderships’ focus on encouraging our members to work in new delivery models through our Board of Trustees Working Groups, the Council on Healthcare Systems and Financing, Committee on RBRVS, Work Group on Integrated Care, and the Council on Psychosomatic Medicine.
The APA administration is in the process of reviewing the rule for more specifics regarding these new codes and other provisions of the proposed rule. A final rule is expected to be issued in November.