JGIM LETTERS William Douglas Tynan, Ph.D. Office of Integrated Health Care , American Psychological Association, Washington, DC, USA. JGen Intern Med 33(10):1596 The two models as described do not accurately reflect DOI: 10.1007/s11606-018-4513-8 existing models in terms of staffing, mode of services, and © Society of General Internal Medicine 2018 time per patient. All the cost data results from those assump- tions and so are questionably valid. The independent variable, the two types of integrated care, do not align to CoCM or PCBH models described in the literature. The basic models and independent variables to be compared are flawed, hence Basu et al. developed sophisticated models of costs and reve- accurate financial conclusions cannot be reached. nue to evaluate the fiscal viability of two behavioral health In addition, as health care moves away from fee for service integration models—the Collaborative Care Model (CoCM) billing to payment for quality and outcome, the impact of and Primary Care Behavioral Health (PCBH). They conclude improved clinical outcome has an impact on payment. Fiscal that the CoCM model will take less staff time per patient and modeling therefore must include variables such as reductions will generate more revenue. in emergency visits and rehospitalizations. A model simply The fiscal data flows from the models presented but an focused on reducing costs and increasing fee for service is not examination of the two models described raises serious viable. concerns. The authors define the first model (CoCM) as a nurse care Corresponding Author: William Douglas Tynan, Ph.D.; Office of manager providing telephonic care management only, with 1 Integrated Health Care American Psychological Association, Wash- hour per week of psychiatry time to supervise an active case- ington, DC, USA (e-mail: email@example.com). load of 120 patients with depression. No face-to-face time with a mental health provider is included in this model. Compliance with ethical standards: This definition does not match the CoCM model studied Conflict of interest: The authors declare that they do not have a and described in the literature. Recommended staffing for conflict of interest. psychiatric providers with an active panel of 120 patients is 4 hours per week, along with two or three care managers who , 3 provide face-to-face service and telephone contact. Of the REFERENCES more than 80 RCT studies of CoCM, none have used tele- 1. Basu S, Landon BE, Williams JW Jr, Bitton A, Song Z, Phillips RS. phone contact only. Moreover, the time per patient calcula- Behavioral Health Integration into Primary Care: a Microsimulation of tions do not reflect the research cited by the authors. Basu et al. Financial Implications for Practices. J Gen Intern Med. 2017 Sep 12. doi: https://doi.org/10.1007/s11606-017-4177-9. state that their telephone sessions are 35 minutes while the 2. Integrated Care: A Guide for effective implementation. Raney LE, Lasky study they referenced indicates 51–60minutes on average. GB, Scott C, editors. Arlington, VA: American Psychiatric Publishing, The second model, PCBH, includes a licensed mental Incorporated; 2017. 3. Tice JA, Ollendorf DA, Reed SJ, et al. Integrating behavioral health into health professional who bills for mental health services pro- primary care. Institute for Clinical and Economic Review (ICER). 2015. vided while embedded within the primary care clinic team. 4. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC.Twelve- Basu et al. define behavioral treatment as eight 45-minute month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 sessions. A recent review of evidence-based therapies deliv- Jun;62(6):629–40. ered in primary care indicates effective treatment in 3–6ses- 5. Linde K, Sigterman K, Kriston L, Rücker G, Jamil S, Meissner K, Schneider A. Effectiveness of psychological treatments for depressive sions. Thus, the course of therapy and total time for therapy in disorders in primary care: systematic review and meta-analysis. Ann Fam PCBH is shorter, not longer, than what would be done in the Med. 2015 Jan-Feb;13(1):56–68. doi: https://doi.org/10.1370/afm.1719. CoCM. Review. Published online June 5, 2018
Journal of General Internal Medicine – Springer Journals
Published: Jun 5, 2018
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