The insurance industry’s manufactured separation of mental health services from more “traditional” medical care in billing codes has long been a source of frustration for health care professionals, creating unnecessary confusion and endangering the health of patients whose illnesses often have both physical and mental components.
But a Colorado-based nonprofit insurance company is striving to change that with a first-of-its-kind integration program aimed at combining the disparate services into a single, coordinated primary care model, as part of a broad effort to shift the U.S. health care industry towards more primary care. Under the pilot program, Rocky Mountain Health Plans will provide so-called “umbrella payments” to three primary care practices to encourage integrated patient care, while giving per-visit fee-for-service reimbursements to three other practices that will serve as control groups for the experiment:
Care could include a traditional office visit with a doctor or a health coach, email exchanges, telephone counseling or a typical counseling session. Patients will get all the care in the familiar setting of their primary care office. [...]
The aim is to prove quickly that patients do better when doctors are paid to keep patients well rather than worrying about seeing as many patients as fast as possible to keep the cash flowing. Rocky Mountain ultimately wants to change the way it pays providers throughout Colorado and spur change around the country.
“This is not an academic exercise,” said Patrick Gordon, director of government programs for Rocky Mountain and executive director the Colorado Beacon Consortium, a coalition of nonprofit health groups that is seeking to boost the quality and efficiency of health care in western Colorado. “This will be a transformative pilot that is being built with the goal of replicating success across the country.”
One of the biggest hurdles to instituting these more efficient, primary care models is adequate financing — that’s why Rocky Mountain will be injecting funds into the Colorado health care system to jump-start reform efforts. “We’re going to take [that hurdle] off the table. Here is the financial support to make this sustainable,” Gordon said.
The stratification of care under the status quo is emblematic of a larger, systemic failure within the health care industry to coordinate care efforts and consequently reduce costs while improving care quality. Rocky Mountain’s mental and physical health service integration program models the way that Obamacare has already encouraged greater coordination between separate elements of the health care industry and an emphasis on primary care.