COVID-19 Impact on Behavioral Health: Collaborative Care is an Essential, Cost-Effective Solution


The COVID-19 pandemic has created an increased demand for behavioral health services. In a recent Kaiser Family Foundation poll almost 50 percent of people reported that coronavirus was having a negative effect on their mental health.[1] Contributing factors include increased social disconnection, a compromised sense of safety and worry about financial security (which is also associated with an increased suicide risk).[2] In addition, up to 30 percent of the population may develop new behavioral health conditions.[3] The brunt of this demand will be felt by primary care practices where most patients seek behavioral healthcare. Primary care providers do not generally have the training, expertise nor time to treat patients with behavioral health needs.[4] To address the increased demand for behavioral healthcare they should adopt evidence-based models, such as collaborative care, that integrate primary and behavioral healthcare.

In this brief, we outline five key requirements to quickly and cost-effectively stand up or expand collaborative care.


1. Incorporate Four Core Evidence-Based Features into the Integrated Model

There are many types of integrated models. For the purposes of this brief we will use the term “collaborative care” to describe those models with features that have been demonstrated to be effective through extensive research and our own experience. These features include:

2. Adapt the Model to Address the Behavioral Health Needs Specific to COVID-19

Strategies are needed to appropriately allocate limited resources based upon the severity of symptoms and risk for developing behavioral health conditions. High-risk groups include seniors, patients with chronic medical conditions, COVID-19 patients or individuals in direct contact with these patients (e.g., first responders, healthcare employees and caretakers) and those whose financial security is threatened. The following strategies are important:

3. Use Collaborative Care Codes to Generate Revenue

The collaborative care billing codes developed by the Centers for Medicare and Medicaid Services (CMS) are increasingly being adopted by private payors and state Medicaid divisions. Compared with traditional episode-based billing for psychotherapy, collaborative care code reimbursement is based upon time spent delivering care management and behavioral health services through a team-based approach. This enables the practice to utilize a broader complement of providers and staff with fewer restrictions on how they are deployed when using telehealth. The use of these codes has enabled many primary care practices to build financially sustainable, if not profitable, programs. To be successful, practices should make the following operational changes:

4. Adopt Telehealth as the Primary Vehicle for Delivering Collaborative Care

Despite compelling evidence that telehealth is as effective as face-to-face clinical encounters for most types of outpatient behavioral healthcare,[6] regulatory barriers have limited its adoption. With the advent of the COVID-19 pandemic, CMS has eased regulations for the use of telehealth for behavioral healthcare and other clinical services to mitigate the barriers to access resulting from the need for social distancing.[7] The transition is already occurring in many primary care practices that are seeing dramatic reductions in in-person visits. Using telehealth has quickly moved from an “innovation” for early adopters to an absolute requirement for all practices to deliver care.[8]

5. Launch or Rapidly Grow Collaborative Care Programs in the Next 30-60 Days

Healthcare organizations must be innovative, practical and strategic to quickly stand up or expand collaborative care programs to meet the increased demand for behavioral health support due to the pandemic. Fortunately, there is over 20 years of industry experience that can provide useful guidance and insights.[10]

Conclusion

The COVID-19 pandemic is forcing dramatic changes in how primary care is delivered. Many of these changes will likely endure as we learn new ways to deliver care more efficiently and conveniently, particularly through telehealth. Integrating behavioral healthcare through the adoption of the collaborative care model is critical to address the full impact of the pandemic and to position primary care practices for the future.

Sources

  1. https://www.kff.org/report-section/kff-health-tracking-poll-early-april-2020-the-impact-of-coronavirus-on-life-in-america-coronavirus-findings/
  2. Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000-11. Lancet Psychiatry. 2015 Mar;2(3):239-45. doi: 10.1016/S2215-0366(14)00118-7. Epub 2015 Feb 25.
  3. Bonanno GA, Brewin CR, Kaniasty K, Greca AM. Weighing the Costs of Disaster: Consequences, Risks, and Resilience in Individuals, Families, and Communities. Psychol Sci Public Interest. 2010 Jan;11(1):1-49. doi: 10.1177/1529100610387086.
  4. Crowley RA, Kirschner N. The Integration of Care for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into Primary Care: An American College of Physicians Position Paper. Ann Intern Med. 2015;163:298–9.
  5. PHQ-9 (Patient Health Questionnaire), GAD-7 (Generalized Anxiety Disorder scale), AUDIT (Alcohol Use Disorders Identification Test), DAST (Drug Abuse Screening Test).
  6. Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health. 2013 Jun;19(6):444–454. Available at https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3662387/.
  7. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
  8. Mostashari F. COVID-19 pushing primary care to the brink of collapse. https://www.modernhealthcare.com/opinion-editorial/covid-19-pushing-primary-care-brink-collapse.
  9. [iii] https://www.healthleadersmedia.com/clinical-care/how-telemedicine-can-drive-change-behavioral-health-services
  10. Dissemination of integrated care within adult primary care settings: The Collaborative Care Model. American Psychiatric Association Academy of Psychosomatic Medicine. https://www.integration.samhsa.gov/integrated-care-models/APA-APM-Dissemination-Integrated-Care-Report.pdf

Other Behavioral Health Perspectives from The Chartis Group

COVID-19: Four Approaches to Addressing Behavioral Health Impact

Investing in Behavioral Health: A New Perspective

The Behavioral Health Crisis: A Roadmap for Academic Health Center Leadership in Healing our Nation

Authors

Mark B. Wenneker, MD
Principal, Behavioral Health Segment Leader, The Chartis Group
[email protected]

Virna Little, PSyD, LCSW-r, SAP, CCM
Chief Operating Officer and Co-Founder, Concert Health
[email protected]

Jennifer Pinto, LMHC
Senior Vice President for Clinical Services and Innovation, Old Colony YMCA
[email protected]

Alejandro Dan Mendoza, MD
Director of System Integration, Department of Psychiatry, Beth Israel Deaconess Medical Center
am[email protected]

Pamela Damsky
Director, Service Line Planning, The Chartis Group
[email protected]