The National Alliance on Mental Illness estimates nearly 44 million American adults experience mental illness in a given year. That’s one in eight Americans. That also means chances are good that your primary care practice currently has patients with behavioral health conditions.
Since 2017, the Centers for Medicare and Medicaid Services has been reimbursing primary care providers that add Behavioral Health Integration (BHI) services to its chronic care management or collaborative care management programs. But despite this opportunity for additional reimbursement for providers and the obvious health benefit to patients of increased access to mental health services, many practices have shied away from taking advantage of it, says Faith Jones, director of care coordination and lean consulting for HealthTechS3.
“If you’re already doing a care coordination program around chronic care management, then BHI is a natural next step,” she says. “It’s nearly identical to what you’re already doing for your patients.”
And the benefits are numerous. You can bill for it. CMS reimburses CCM at $42 per patient per month; it’s $48 for BHI. What’s more, Jones says, these patients are already in your practice, “so recruitment isn’t an issue.”
But perhaps most important is the overall benefit it provides to the patient’s health outcomes. “If we don’t focus on the behavioral health issues, we’re going to have a time getting a handle on the chronic care, because increasingly we’re discovering that all of these issues are intertwined,” she says.
Much of the hesitation about BHI center around two myths that are easily dispelled.
This is the No. 1 question Jones receives about BHI. Are there quantitative measures, much like regular blood pressure readings for a patient with hypertension, for behavioral health conditions?
“Sometimes we don’t think about having access to objective information around mental health, and that it’s somehow harder to track,” she says.
But validated tools do exist, such as the GAD-7 survey for anxiety and PHQ-9 for depression.
“Those are objective tools to help us really track how patients are doing with their mental health issues,” Jones says.
Concerns about staffing for BHI
Just as you can manage a patient’s hypertension through your care coordination program without having a cardiologist on staff, the same is true for behavioral health. It’s the care coordinator’s job to locate those external resources, connect the patients to them and regularly consult with them.
This is the biggest challenge with BHI, especially in rural communities where access to behavioral health care is already short in supply, Jones says. “You definitely have to be more creative in locating these resources, because in some communities they can be few and far between.”
Telehealth is one solution. Multi-state licensing compacts also can increase the availability of providers to any given area. Jones also recommends establishing relationships with mental health providers in your state’s metropolitan areas. They may be several hours away, but if they’re licensed to practice in your state, then it’s a viable solution for telehealth or even a visiting specialist clinic.
Implementing BHI in your practice
There are five components to the BHI service, which all must be satisfied in order to bill monthly for the service.
1. Initial assessment includes an initiating visit (if required) and the administration of applicable validated rating scales, such as the GAD-7 or PHQ-9. An initiating visit is required for new patients not seen within one year prior to the commencement of BHI services.
2. Systematic assessment and monitoring, including re-administration of the applicable rating scales.
3. Care planning, which is done in conjunction with the patient. Treatment may include pharmacotherapy, psychotherapy, and/or other indicated treatments. Care plan revisions should be made as needed for patients whose conditions are not improving adequately.
4. Facilitation and coordination of behavioral health treatment.
5. Continuous relationship with a designated member of the care team.
CMS allows all of these service components to be performed by the billing provider—a physician and/or non-physician practitioner, typically primary care but can be a specialist, too. CMS further states that the services may be provided in full by a qualified clinical staff (behavioral health experience optional) using a team-based approach.
So, where are the behavioral health specialists? CMS does state that BHI can involve a behavioral health specialist or psychiatric consultant, but that’s optional. However, both are required in the more robust Psychiatric Collaborative Care Services (CoCM) program, which goes a couple of steps further. In CoCM, patients engage in “proactive, systematic follow-up” with a behavioral health care provider and the billing provider must hold (at least) weekly case load reviews with a psychiatric consultant.
Whether you’re interested in learning more about BHI or how to implement CoCM in your practice, tune into Jones’ upcoming webinar, “Managing Behavioral Health Patients in Your Primary Care Practice With Collaborative Care Management,” on Thursday, March 26 at noon CST. Reserve your spot today.