“One of the clinics in the Oregon’s Alternative Payment Methodology (APM) Pilot estimated that nearly half of the patients in its population has either depression or some other health issue with a behavioral health-related diagnosis. For many patients, long-term therapy and a 50-minute visit is not needed to help with their mild to moderate emotional or behavioral problem. In these cases, behavioral health clinicians can offer brief, problem-focused therapy. In this model, the behavioral health clinicians become familiar with the clinic’s panel of patients, and the team moves to a truly population-based approach. As of yet, however, this level of integration still remains the promise of a new care model rather than the current reality.
The Role of Payment Reform
All of the practices we have visited are early adopters, and while money is not the motivating factor for these practices (how could it be?), financing must be addressed to sustain integration efforts. If the primary way a health provider is paid is through physician visits (which is how providers were paid under the Fee-for-Service model), then it’s extremely hard to finance an integrated health care model. The APM pilot is one step toward a payment system that better enables health systems to implement integrated care in a financially viable way.
While APM is not specifically funding primary care-behavioral health integration, it is freeing up practices to look more broadly at how they treat their patients.The practices in the APM pilot do not have requirements for how to they spend their PMPM fee. Therefore, instead of needing to generate a high number of physician-patient primary care visits, they now have the flexibility to spend some of their fees on behavioral and mental health services. As long as the net effect is budget-neutral, they can treat patients in new ways and with new combinations of providers.
Integrated care is comprehensive primary care. To make it common practice will require leadership to push further on paying for services that are central to comprehensive primary care, align payment across payers to reduce complexity, and support system-wide practice change.”