Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff
Open accessAbstract
Background 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.Objective 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.Approach 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.Key results 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.Conclusions With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.
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Complex financing strategies may require their own implementation support, as considerable challenges to execution have been observed.
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Three Approaches to Qualitative Content Analysis
Hsieh, H.-F., & Shannon, S. E. (2005) · Qualitative Health Research · doi:10.1177/1049732305276687 · Cited by 44,601 · see citing works
(2008) · Springer eBooks · doi:10.1007/978-0-387-77282-0_6 · Cited by 17,410 · see citing works
Collaborative care for depression and anxiety problems
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006525.pub2 · Cited by 1,126 · see citing works
Woltmann, E., Grogan-Kaylor, A., Perron, B., Georges, H., Kilbourne, A. M., & Bauer, M. S. (2012) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.11111616 · Cited by 603 · see citing works
Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder
Fortney, J. C., Pyne, J. M., Kimbrell, T. A., Hudson, T. J., Robinson, D. E., Schneider, R., Moore, W. M., Custer, P., Grubbs, K. M., & Schnurr, P. P. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1575 · Cited by 275 · see citing works
Medicare Payment for Behavioral Health Integration
Press, M. J., Howe, R., Schoenbaum, M., Cavanaugh, S., Marshall, A., Baldwin, L., & Conway, P. H. (2016) · New England Journal of Medicine · doi:10.1056/nejmp1614134 · Cited by 86 · see citing works
Engel, C. C., Jaycox, L. H., Freed, M. C., Bray, R. M., Brambilla, D. J., Zatzick, D., Litz, B. T., Tanielian, T., Novak, L. A., Lane, M. E., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.2402 · Cited by 77 · see citing works
Huffman, J. C., Mastromauro, C. A., Sowden, G. L., Wittmann, C. W., Rodman, R., & Januzzi, J. L. (2011) · Psychosomatics · doi:10.1016/j.psym.2010.11.021 · Cited by 66 · see citing works
O’Malley, A. S., Sarwar, R., Keith, R., Balke, P., Ma, S., & McCall, N. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4134-7 · Cited by 53 · see citing works
Basu, S., Phillips, R. S., Bitton, A., Song, Z., & Landon, B. E. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2677 · Cited by 50 · see citing works
Financing for Collaborative Care—a Narrative Review
Carlo, A. D., Unützer, J., Ratzliff, A., & Cerimele, J. M. (2018) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-018-0150-4 · Cited by 49 · see citing works
Self-citationEngel, C. C., Bray, R. M., Jaycox, L. H., Freed, M. C., Zatzick, D., Lane, M. E., Brambilla, D. J., Olmsted, K. R., Vandermaas-Peeler, R., Litz, B. T., et al. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.10.002 · Cited by 39 · see citing works
Basu, S., Landon, B. E., Williams, J. W., Bitton, A., Song, Z., & Phillips, R. S. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4177-9 · Cited by 29 · see citing works
Cerimele, J. M., Halperin, A. C., Spigner, C., Ratzliff, A., & Katon, W. J. (2014) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.07.013 · Cited by 18 · see citing works
Self-citationSolberg, J. J., Deyo-Svendsen, M. E., Nylander, K. R., Bruhl, E. J., Heredia, D., & Angstman, K. B. (2018) · Journal of Primary Care & Community Health · doi:10.1177/2150132718773266 · Cited by 7 · see citing works
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McGinty, E. E., & Daumit, G. L. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000183 · Cited by 88 · see citing works
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Dopp, A. R., Kerns, S. E. U., Panattoni, L., Ringel, J. S., Eisenberg, D., Powell, B. J., Low, R., & Raghavan, R. (2021) · Implementation Science · doi:10.1186/s13012-021-01137-9 · Cited by 52 · see citing works
- Authors
- Carlo, A. D., Corage Baden, A., McCarty, R. L., & Ratzliff, A. D. H.
- Affiliations
- University of Washington (US)
- Corresponding author
- Carlo, Andrew D.
- Venue
- Journal of General Internal Medicine
- Published
- 2019-07-31
- Volume
- 34
- Issue
- 10
- Pages
- 2150-2158
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC6816741
- OpenAlex
- W2965148657
- Cited by
- 39
- References
- 17
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 7 · 2023: 8 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 1
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (T32MH073553)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- collaborative care, reimbursement, financial sustainability, licensed clinical social workers, patient consent, organizational buy-in, primary care psychiatry
- MeSH terms
- Medicare, Humans, Leadership, Mental Health Services, Primary Health Care, United States, Fee-for-Service Plans, Delivery of Health Care, Integrated, Qualitative Research, Evidence-Based Practice, Clinical Coding
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