Table of Contents | Key | |
|---|---|---|
Please use the quick links below to jump to preferred topics | Abbreviation | Role |
General | BHCM | Behavioral Health Care Manager |
Staffing | CoCM | Collaborative Care Model |
Billing | PC | Psychiatric Consultant |
Data and Reporting | PCP | Primary Care Provider |
Nomination and Designation Status | SCR | Systematic Case Review |
If you’d like to learn more about CoCM, please reach out MCCIST.
General
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1. We already work collaboratively – how is this different?
Answer: While many clinics and health centers have varying levels of integration and collaborations, CoCM is a particular type of integrated care. In fact, it is the most evidence-based model of integrated care. CoCM is a population health, treatment to target based “system of care” that introduces two new roles (Behavioral Health Care Manager and Psychiatric Consultant) and one new tool (Systematic Case Review Tool).
For more information, please review:
2. I don’t need help treating patients with depression and anxiety, I need help with my more complex patients. Can CoCM help me with my more complex patients?
Answer: Patients with depression and anxiety served through “usual care” often “fall through the cracks,” and often stop coming in, stop taking their meds, and/or don’t have their medications titrated up to a therapeutic dose. They also typically don’t have evidence-based systematic follow-up. CoCM helps to make sure that patients don’t “fall through the cracks” because the patients are tracked in the systematic case review tool and followed closely by the BHCM. CoCM is also a “treat-to-target model of care” which uses validated monitoring scales to monitor progress and treatments (pharmacological and behavioral interventions) are actively adjusted. Evidence shows us that patients enrolled in CoCM get better faster and typically show improvements like those served in specialty care. CoCM can help free up specialty slots for more complex patients. For more information, please review: Primary Care Statement
3. What type of consent is required?
Answer: Per CMS guidelines, the PCP must get verbal consent from the patient and explain cost-sharing. Written consent I not required. For more information, please review: CMS Guidelines
4. Does the psychiatric consultant see the patient?
Answer: Typically, not. In CoCM, the psychiatric consultant provides treatment recommendations to the BHCM and PCP. In the rare instances that a patient was seen by a psychiatrist, this visit would be billed outside of CoCM and according to the patient’s behavioral health benefits.
5. How often do the BHCM and psychiatric consultant conduct systematic caseload review?
Answer: The BHCM and psychiatric consultant meet on a weekly basis. The duration of this meeting will depend on the caseload size; typically, systematic case review will be conducted for 1 hour/week per 0.5 BHCM FTE. For more information, please review: Behavioral Health Care Manager Caseload Guidelines
6. Who writes the prescription?
Answer: If the PCP agrees with the medication recommendation, they will write the prescription.
7. What if the PCP disagrees with recommendation?
Answer: This does happen on occasion. We would recommend that the PCP and/or the BHCM further discuss the case with the PC and possibly get another recommendation.
8. Which patients should be enrolled in CoCM?
Answer: The evidence base for CoCM is for patients aged 12 and up with “mild to moderate” behavioral health diagnoses. The evidence base is growing for other populations. If the PCP or BHCM is not sure whether a patient would be appropriate for CoCM, this can be discussed with the PC. For more information, please review: Identifying patients and Adolescent CoCM
9. Which patients are diagnostically not appropriate?
Answer: Patients with complex or more severe diagnoses typically do not do well in CoCM and should be referred to a higher level of care. Some examples of diagnoses that typically do not do well in CoCM are schizophrenia and significant eating disorders. For more information, please review: Appropriate patients for the model and Adolescent CoCM
10. Can a patient be in both CoCM and traditional therapy?
Answer: Yes. This tends to happen with adolescents more than adults. It takes additional coordination of care to make sure that treatment plans/self-management plans compliment, or at minimum don’t conflict. Time counted towards therapy codes cannot be included in the time counted towards the monthly CoCM codes.
11. If the EHR and SCR are not integrated, will the team need to document in both?
Answer: Yes.
12. How do you gather buy in?
Answer: It is best to have a PCP champion that is actively involved. They can mentor their peers on the program including sharing the positive effects of the program on their patients and on them (patients not falling through the cracks, more time to work with patients on other issues, less ED visits/hospitalizations, how having behavioral health addressed positively impacts physical health). BHCMs can create flyers and brochures to introduce themselves and the program to staff and patients as well as attend staff meetings and huddles. Bringing data and case studies to meetings can also be a positive way to promote CoCM.
Staffing
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1. Who can act as a BHCM?
Answer: Any licensed (including limited licensed) professional with specialized mental health training can act as the BHCM. Typically, BHCMs are social workers or nurses. BHCMs should be comfortable discussing behavioral health issues, completing mental health assessments, and performing the brief behavioral interventions. BHCMs do not provide traditional therapy. Please note: For CoCM only, Priority Health considers a licensed professional counselor as a qualified health professional and can act as a BHCM.
2. Can one BHCM cover more than one practice?
Answer: Yes. It will be important to have enough dedicated time for the BHCM to support multiple practices. Another consideration to having dedicated time is the ability to grow and sustain the program.
3. Who hires the PC and BHCM?
Answer: Depends. In some organizations the Physician Organization (PO) hires/contracts with 1 or both new team members. For other groups, the practice hires/contracts with them directly.
4. Who can act as the PC?
Answer: Preferably the role would be filled by a psychiatrist licensed in Michigan. A psychiatric nurse practitioner or a nurse practitioner, preferably under the supervision of a psychiatrist, can also serve in this role.
5. What is an appropriate CoCM caseload size?
Answer: The CoCM caseload size will depend on BHCM FTE, caseload complexity, patient characteristics (e.g., socioeconomic needs). A typical CoCM caseload for a 0.5 BHCM FTE will be 45-60 patients for predominantly commercial patients. See the AIMs center caseload size guidelines: Behavioral Health Care Manager Caseload Guidelines. If you are working with an adolescent population, the caseload size may be smaller due to coordination with families, schools, courts, etc.
6. If the BHCM, PC, and/or PCP champion has attended separate CoCM training through another organization, will this count toward the required training?
Answer: This should be discussed with your training partners.
Billing
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1. What are the CoCM codes?
Answer: Three CPT codes and 2 codes have been defined for CoCM. These are monthly time based codes that are billed under the PCP. For more information, please refer to the CMS guidelines.
Collaborative Care Model Billing Webinar
Collaborative Care Team Approach: Coding and Billing Opportunities
2. Does the PC bill for their time?
Answer: No, the codes will be billed by the primary care office. The PC is typically reimbursed by the PO or practice.
Data and Reporting
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1. What reporting is needed for this initiative?
Answer: Twice a year on January and July 31st, the Outcome Tracking Tool must be submitted to BCBS through the PGIP portal. Information requested would be the minimal information needed for your SCR tool as well as demographic information. You can obtain this tool through your training partner or on the PGIP page.
Nomination and Designation Status
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1. When can I nominate practices for designation status?
Answer: Please refer to the BCBSM PGIP web page or discuss with your BCBSM representative
2. When does the VBR period start?
Answer: Please refer to the BCBSM PGIP web page or discuss with your BCBSM representative
3. What capabilities are needed for designation status?
Answer: Please follow this link to the capabilities.