MLive
This article was originally published at MLive

Advocates of a decades-old model that integrates mental health care into primary care say expanded access through the team-based system could save 14,000 lives annually.

However, less than 1% of the nearly 60 million adults and children with mild and moderate mental illness benefited from the collaborative care model in 2022, according to a study released Tuesday, May 20, by the Washington D.C.-based advocacy group Path Forward.

The study analyzed claims data for 219 million Americans between 2018 and 2023. It found significant growth in both provider and patient participation across all insurance types.

Still, only about 100,000 people using commercial insurance were treated using the team-based care model in the latest year, signaling a need for more provider and community buy-in.

“The collaborative care model is the gold standard for delivering mental health in primary care settings because mental health is, at its core, simply a very important part of health,” said Andy Keller, president and CEO of the Meadows Mental Health Policy Institute, which commissioned the study.

“This model is the single most impactful step we can take to get upstream, before tragedy strikes, to make Americans healthy again.”

Collaborative care leverages the coordinated efforts of a primary care or specialty medical care provider, a behavioral health care manager, and a psychiatric consultant to weave mental health care into primary care.

In 2018, Michigan had about 265 patients with public insurance and 364 with commercial insurance receive collaborative care. Those numbers increased to 4,560 and 6,498 in 2022.

Similarly, physicians billing for collaborative care increased from 60 to 343 in Original Medicare, from 44 to 430 in Medicare Advantage, and from 15 to 159 in Medicaid. Provider counts for commercial insurance were not available.

A handful of Michigan communities stand out nationally.

Jackson ranked first in the U.S. in patients with Medicare Advantage receiving care under the model, and second in patients with Original Medicare. Those rates were 24 times and 11 times the national average.

Ann Arbor ranked No. 4 nationally for patient participation among Medicare Advantage recipients. It ranked No. 5 for Original Medicare recipients, followed by Saginaw at No. 6.

“There are some real white knights and some real winners in the nation and one of those is Michigan,” said Anna Bobb, Path Forward’s executive director. “We need to commend Michigan for being a leader in this.”

A national shortage of mental health professionals has contributed to limited access to behavioral health care in the U.S., leading to barriers to timely care, especially in rural and underserved communities.

Patients typically first present with mental health concerns in primary care settings. For example, the majority of people who die by suicide visit a primary care provider in the months leading up to their death.

By adopting a collaborative model, health systems can close gaps in capacity that contribute to underdiagnosing, inadequate treatment, and missed opportunities for early intervention.

“There’s a 10-year delay that’s been documented between the time someone has symptoms of a mental illness and is diagnosed,” Bobb said. “That delay is what causes a lot of problems of ending up in an emergency room or even worse, and 10 years of suffering that could be avoided.

“That delay is what the collaborative care model is going to reduce significantly.”

Multiple studies have found a more than 50% reduction in suicide risk among at-risk patients after enrollment in a collaborative care model program.

Psychiatrists’ time is also better leveraged with the model, allowing them to see eight times as many patients, according to Bobb.

While the concept of collaborative care was developed in the 1990s, it wasn’t until 2017 that dedicated billing codes were established to make insurance reimbursement a reality.

Michigan is one of 22 states that have activated the collaborative care model billing codes for Medicaid and Children’s Health Insurance Program (CHIP).

Also contributing to the state’s success is strong health system adoption, strong reimbursement policy from commercial insurance, and philanthropic giving to help health care centers overcome transition costs.

Adoption of the model comes with challenges. Physicians have to change their workflow. Systems have to hire and incorporate new people into their care teams and update billing.

“With collaborative care payment codes, we’ve created sort of a glide path after the change is done,” Bobb said. “Once you finish that change effort, we have sustainability.”

Meadows Mental Health Policy Institute sought a study to assess how adoption of collaborative care has evolved since dedicated billing codes were recognized by The Centers for Medicare & Medicaid Services (CMS).

Bobb called it the first ever national analysis of the collaborative model in the real world, adding that people in the know have a deep admiration for it.

“It’s very powerful in terms of identifying depression and anxiety early and getting them treated,” Bobb said.

Where rural communities tend to face shortages of providers and overall access to care, the collaborative model can alleviate some of those challenges by bringing in psychiatric consultants through telehealth.

Looking to the future, advocates for the collaborative model want to see Medicare reimbursement rates increase. The Complete Care Act, proposed in the U.S. Senate in March, would do just that for three years as a means to incentivize behavioral health integration with primary care.

The federal bill was referred to the Senate Finance Committee, where it remained as of Tuesday. A similar bill was introduced in 2023 and never made it out of committee.

MLive
This article was originally published at MLive