Insurers warm to behavioral health in primary care
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Insurers increasingly are paying for behavioral health services that are delivered in coordination with primary care, according to a new claims analysis from Milliman.
Why it matters: The idea of coordinating mental health care with physical health care has been around since the 1990s. But Medicare billing codes adopted in 2017 have made such arrangements viable in both private and public insurance markets, the report shows.
Context: The system, known as the collaborative care model, involves having a patient's primary care provider, behavioral health manager and psychiatric counselor create and carry out a mental health treatment plan.
- Traditionally, mental health care is delivered separately from physical health care, which can make it difficult to coordinate across providers.
- Studies have shown the collaborative care model improves outcomes, and there's also evidence that it can also reduce costs, per the report. Health systems began piloting the model using grant funding before Medicare introduced billing codes for the services.
What they found: The number of Medicare Advantage enrollees receiving behavioral health services through the collaborative care model has increased eightfold since billing codes became available in 2017.
- About 2,600 MA beneficiaries got collaborative care in 2018, compared with 20,780 in 2022, Milliman found.
- The number of enrollees in traditional Medicare using the services grew more than five times over the same period. Medicaid uptake increased more than nine times, reaching 30,930 people in 2022.
- Growth in the commercial market has been significant, too: About 1,650 commercially insured people used collaborative care in 2018. That figure topped 27,440 in 2022, and nearly 36,600 in 2023.
Yes, but: The growth of the model in a handful of cities across the country drove much of the national increase, the analysis found.
- In Madison, Wisconsin, 1,524 people out of 100,000 with commercial insurance got collaborative care services in 2023. That's compared with a national average of about 59 patients out of 100,000.
- Madison also had the highest participation in the country for traditional Medicare enrollees and the third-highest for Medicare Advantage.
- Arizona had the highest proportion of Medicaid enrollees using collaborative care among all states in 2022.
Factors that helped growth in high-uptake communities include support from health systems, primary care physicians who champion the model, and philanthropic support for startup costs, said Anna Bobb, executive director of the mental health advocacy coalition Path Forward.
What to watch: Bipartisan legislation introduced in Congress would increase Medicare reimbursements for existing behavioral health providers in collaborative care, which advocates say would boost access to the services.
Zoom in: Milliman's analysis is based on Centers for Medicare and Medicaid Services data and the consulting firm's own dataset that together represent about 219 million people. Public payer data was available through 2022, and commercial market data through 2023.
- The Meadows Mental Health Policy Institute commissioned the report.
