Using CoCM to Close Care Gaps and Enable Better Outcomes

By Charles Hutchinson, InSync Healthcare Solutions

Managing patients who need ongoing behavioral health services to treat anxiety, depression, substance-use disorders or other issues is getting harder.

More than 43 million adults, or one in five Americans, is diagnosed with a mental illness in a given year, according to the Centers for Disease Control and Prevention (CDC). But we’re running short on primary-care and behavioral healthcare providers, especially in rural areas.

The good news? Tightly integrated care between PCPs and BH providers can help alleviate this problem. What’s even better? CMS now reimburses providers for collaborating.

In 2018, the agency unveiled a new Psychiatric Collaborative Care Model (CoCM) within its Physician Fee Schedule. Under this model, a primary-care physician oversees a team-based approach and ensures behavioral health expertise is integrated into the patient care experience.

The benefits of such team-based approaches are documented studies like these, which emphasize the correlation between integrated care, higher quality and lower costs. A separate study, published in October by the American Psychiatric Organization, emphasized CoCM’s advantage over the approach of “colocation” of mental health services in reducing depressive symptoms among primary-care patients.

However, not all providers are plucking the low-hanging fruit.

Understanding Challenges

While BH providers understand the theory of the CoCM model, the devil is in the details.

Figuring out how to structure collaboration when everyone uses different tools and technology systems, from EHRs and scheduling systems, can create some confusion, or workflow interruption among care partners.

Because every partnership between PCPs and BH providers is unique, ironing out the guidelines for teamwork (e.g., what PCPs will seek guidance for, such as psychiatric medications, or more comprehensive care), can seem overly time consuming.

There are also fears of violating patient regulations by sharing information electronically. Recent updates to 42 CFR Part 2 (Part 2) law, which center on safeguarding the confidentiality of the patient records, have put behavioral health in the spotlight again in regard to patient privacy.

Under the updated law, Part 2 programs and lawful holders are required to have established formal policies and procedures for the security of both paper and electronic records, according to the Substance Abuse and Mental Health Services Administration (SAMSHA).

The fear of violating patient privacy legislation and facing stiff monetary penalties is real. Part 2’s alignment with HIPAA privacy protections opens healthcare organizations up to potential civil penalties or worse.

Coming Together

Building a successful CoCM partnership comes down to alignment: PCPs and BH providers must align care, agree to exchange data securely, through interoperable technology platforms, and make other adjustments as needed.

This kind of alignment starts with conversations about what tools and workflows support CoCM: Are there preferred communication styles on the part of one provider or another? How will an integrated workflow actually work in practice? How will care partners benefit? How will patients benefit?

Beyond these initial conversations, it’s also important to consider the role that communications technology will play.

The number of BH providers that use EHRs has increased significantly since 2012, when just 21 percent of behavioral health organizations claimed to use them. But it still isn’t on par with the EHR use by PCPs, in spite of incentives by the Office of the National Coordinator for Health Information Technology (ONC) to promote health data exchange and EHRs in behavioral healthcare settings.

In addition to concerns over CFR 42, one survey suggests as many as one out of every four BH providers who don’t use EHRs believe the technology is too time-consuming. Nearly as many say it causes confusion.

Regardless of the reason, when providers aren’t using EHRs, engaging in collaborative tasks becomes more cumbersome and time-consuming.

In order to move forward with our partners, we must listen and communicate our concerns. Perhaps one of our partners had a bad experience with collaboration. Or, perhaps our existing IT solutions can’t support the kind of collaboration envisioned by CMS.

The bottom line is that EHRs and other technology platforms must make the act of sending and receiving healthcare data easier so patients have a more holistic, seamless care experience – and better outcomes. What our technology shouldn’t do is make collaboration more cumbersome and time consuming.

As the number of patients who need comprehensive, high-quality behavioral healthcare rises, mitigating these obstacles to collaboration is essential. We need our workflows and tools to support our clinical practice and the patients we serve — today and in the future.

About The Author

Charles Hutchinson is the CFO of InSync Healthcare Solutions.