Sustainable payment model analysis for integrated medical-behavioral primary care practice

The state of Colorado has implemented integrated behavioral healthcare in primary care medical settings under a Centers for Medicare and Medicaid Services State Innovation Model Award. This program includes about 325 primary care practices across the state and four community mental health centers where physical healthcare is being integrated into the mental health practice.

A key challenge of this initiative is the financial sustainability of the integrated care practices after the federal support ends.

In this paper, Milliman’s Steve Melek, Katie Matthews, and Ally Weaver present a payment model that they believe would support the sustainability of integrated care practices while also helping payers to control healthcare costs. They look first at commercial payer spending on primary care and outpatient behavioral services and then examine the costs of building and maintaining an integrated primary care practice from the providers’ perspective.

They build their integrated primary care practice using a “teamlet” approach. Their design also addresses the primary care physician shortage by adding a nurse practitioner and physician assistant to the integrated primary care practice. It includes medical assistants and licensed practical nurses to complete the medical team.

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