Table 2.

Reimbursement Strategies Under Emerging Payment Structures to Promote Integrated Mental Health Care Using the Chronic Care Model

Stage	Procedures
Background/Initiation	Work with payers in your region/state to come to consensus on the value of the Chronic Care Model (CCM) and agree on tracking key outcomes. Provide evidence of inadequate mental health treatment and costs in your region/state. If applicable, involve local chapters of national organizations including the AMA, national social workers and nurses associations, National Council of Community and Behavioral Health Care, and the National Alliance for the Mentally Ill
	Identify the following characteristics of your care delivery environment:
	1) Provider type: Who is providing the care?
	2) Location of service: At what type of facility is the care being delivered? Payer: Which organization is reimbursing for the care?
	3) Content of intervention: What type of intervention is being delivered?
	Develop an integrated care CCM toolkit for frontline providers that includes appropriate codes, outcomes measures, guidelines, self-management materials.
Negotiation	Establish a working group consisting of multiple stakeholders (e.g., providers, payer representatives), get their input on what’s in it for them, and based on their feedback, develop a core set of outcomes to benchmark CCM implementation:
	Patients—improved access to MH, improved outcomes (e.g., symptoms, functioning), and improved ability to gain contact by phone for their needs
	Providers—improved access to mental health and backup for depressed patients who do not tend to follow through, better outcomes in state data
	Employers—patients back to work, productivity
	Insurance companies—reduced ED and hospital utilization
	Publicize initial effectiveness early on to stakeholders
	Propose a reimbursement model using existing fee-for-service mechanisms with an eye towards developing a bundled payment model. Involve a third party to help negotiate payment rates for new reimbursement models
	Engage in conversations with established or potential accountable care organizations in your area, and if applicable, state health care exchanges regarding the value of applying the CCM to integrate mental health and general medical care, and under parity, to make behavioral health care part of the medical care benefit package and reimbursement mechanism. Be involved in the negotiations over how these organizations will operationalize the integration of mental health services into primary care settings and how mental health providers, including nurses and clinical social workers, will be reimbursed
Current Strategies: fee-for-service payment structure	Start with existing billing codes: e.g., Table 1, and reference national sources such as the State Financing Integrated Healthcare Worksheets, available at the SAMHSA-HRSA Center for Integrated Health Solutions (http://www.integration.samhsa.gov/financing/billing-tools) on the use of codes
	Contact all contracted payers to determine if and how much they reimburse for the codes identified and what documentation is needed.
	If payers do not reimburse for codes you think are important, consider engaging in advocacy to “turn on” new codes and pilot the process in primary care practices, especially codes that can jump-start key CCM processes including self-management, assessment, and care management
Emerging Strategies: bundled payment structure	Consider initiating a pilot program with payers to receive a payment based on how many patients fit into the integrated mental health–CCM services being delivered (e.g., DIAMOND demonstration). Bundled payments should cover start-up costs of CCM practice redesign components in primary care, including the development of a registry and measurement-based care tools