The COVID-19 pandemic has spurred a dramatic increase in depression, anxiety, and other mental health conditions.1
Family physicians can play a key role in managing these conditions, as well as bipolar disorders, substance use disorders, grief reactions, post-traumatic stress disorder, etc. — especially in areas where mental health resources are scarce — by using the psychiatric collaborative care model.
The model relies on a care team made up of the primary care physician, a behavioral health care manager (someone with behavioral health training, such as a psychologist, social worker, or nurse), and a psychiatric consultant (someone who is qualified to prescribe the full range of behavioral health medications but usually does not meet patients face-to-face). A primary care practice could contract with the care manager and consultant and pay them on a per-patient basis instead of making them employees.
The team then follows these steps to integrate behavioral health monitoring into primary care:
1. Referral — The physician identifies patients who seem likely to benefit from the program.
2. Consent — The patient agrees to join the program, and consent is documented in the medical record.
3. Warm handoff — The physician introduces the patient to the behavioral health care manager, who will be the patient’s main point of contact for the program.
4. Initial psychosocial exam — The care manager conducts a comprehensive entry exam that includes family history, eating and sleeping patterns, substance use history, mental health history, use of psychotropic medications, and abuse or trauma history.
5. Administration of validated rating scales — The care manager determines a baseline benchmark for the condition for which the patient is entering the program, so that improvement or deterioration can be tracked.
6. Creation of a care plan — The care manager and patient form a plan that includes the condition being treated, medications, psychosocial needs, and related problems such as sleep disturbances and weight issues. The plan also outlines therapies. The full team reviews it, and it is updated regularly.
7. Entry into a registry — This allows the care team to record patient assessment scores and track progress.
8. Initial psychiatric consultant review — Within the first month, the care manager discusses the patient’s condition with the psychiatric consultant, and they fine tune the care plan in consultation with the primary care physician.
9. Regular check-ins — After the first month, the care manager spends at least 60 minutes per month checking in on each patient, monitoring for medication adherence, progress, and setbacks, and performing basic interventions if necessary. The care team meets each month (or more frequently) to review treatment plans and patient progress.
10. Billing at the end of the month — Psychiatric collaborative care programs are billable through Medicare and other payers, with Medicare paying about $160 per patient for the first month and $130 per patient per subsequent month.
The process may seem daunting, but once the physician has handed off the patient to the behavioral health care manager, much of the day-to-day work is conducted by the care manager and the psychiatric consultant (with the physician’s input).
If you cannot find a qualified behavioral health care manager and psychiatric consultant to partner with, Medicare also covers general behavioral health integration (BHI), a simpler model that can be provided by a physician alone or by a staff member working under a physician. That model pays about $50 per patient per month.
1. COVID-19 and Mental Health: What We Are Learning. Mental Health America. July 1, 2020. Accessed Dec. 18, 2020. https://mhanational.org/sites/default/files/Coronavirus%20Mental%20Health%20Presentation%207-1-2020.pdf
Read the full article in FPM: “Bringing Behavioral Health Into Your Practice Through a Psychiatric Collaborative Care Program.”
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