Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff
Although collaborative care (CoCM) is an evidence-based and widely adopted model, reimbursement challenges have limited implementation efforts nationwide. In recent years, Medicare and other payers have activated CoCM-specific codes with the primary aim of facilitating financial sustainability.
To investigate and describe the experiences of early adopters and explorers of Medicare’s CoCM codes.
Design and Participants
Fifteen interviews were conducted between October 2017 and May 2018 with 25 respondents representing 12 health care organizations and 2 payers. Respondents included dually boarded medicine/psychiatry physicians, psychiatrists, primary care physicians (PCPs), psychologists, a registered nurse, administrative staff, and billing staff.
A semi-structured interview guide was used to address health care organization characteristics, CoCM services, patient consent, CoCM operational components, and CoCM billing processes. All interviews were recorded, transcribed, coded, and analyzed using a content analysis approach conducted jointly by the research team.
Successful billing required buy-in from key, interdisciplinary stakeholders. In planning for CoCM billing implementation, several organizations hired licensed clinical social workers (LICSWs) as behavioral health care managers to maximize billing flexibility. Respondents reported a number of consent-related difficulties, but these were not primary barriers. Workflow changes required for billing the CoCM codes (e.g., tracking cumulative treatment minutes, once-monthly code entry) were described as arduous, but also stimulated creative solutions. Since CoCM codes incorporate the work of the psychiatric consultant into one payment to primary care, organizations employed strategies such as inter-departmental ledger transfers. When challenges arose from variations in the local payer mix, some organizations billed CoCM codes exclusively, while others elected to use a mixture of CoCM and traditional fee-for-service (FFS) codes. For most organizations, it was important to demonstrate financial sustainability from the CoCM codes.
With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.
KEY WORDSmental health payment policy integrated care collaborative care qualitative research
Dr. Carlo, the corresponding author, was supported by an NIH-funded post-doctoral fellowship at the University of Washington entitled “Training Geriatric Mental Health Services Researchers” (NIH project number 6T32MH073553-15).
Compliance with Ethical Standards
All interviews were facilitated by a psychiatrist skilled in interviewing techniques and were audio-recorded and professionally transcribed. No honorarium was provided for study participation. This protocol was reviewed and granted exemption by the University of Washington Human Subjects Division (00003585).
Conflict of Interest
Dr. Ratzliff receives royalties from Wiley. All the remaining authors declare that they do not have a conflict of interest.
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