News & Commentary

How to Get Parity For Mental Health

Integrating behavioral health and primary care — a way some hope to reach the long-sought goal of mental health parity — might actually increase costs, at least in the beginning, according to a study by the Institute for Clinical and Economic Review (ICER).

However, the institute, a not-for-profit research organization, thinks that the collaborative care model (CCM) might be a way to make this work, and insurers will be a pivotal player.

“Health plans should design benefits and provider networks to support a role for behavioral health providers as members of primary care teams and not require that patients pay specialist-level copayments for these providers,” ICER researchers say in a policy brief.

An alternative would be to allow a single copayment per visit cover any care provided by the primary care team, including the behavioral health provider. Keep it simple, the institute says, and allow “behavioral health and physical health visits to be billed on the same day.”

Be patient as well. CCM interventions for behavioral problems (which researchers define as mostly depression and anxiety) might cost more in the first six months to two years than usual care. Costs vary widely, depending on region and the particular population being served, ranging from $20 to $3,900 per patient within the first two years, the policy brief says.

However, the eventual cost-­effectiveness ratio of $15,000 to $80,000 per quality-adjusted life year falls within generally acceptable thresholds for cost-effectiveness.

Behavioral health providers usually use Activate Health and Behavior Assessment and Intervention codes to bill. PCPs use evaluation and management codes. The policy brief’s authors suggest an easing “on licensing requirements for the use of different billing codes to be more inclusive of behavioral health clinicians….”

Also, say the authors of the brief, providers should be reimbursed for telehealth visits. “Since the availability of psychiatrists and other behavioral health clinicians is often limited, expanding telehealth reimbursement would allow for a broader geographic distribution of behavioral health consultations.”


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