2. Maximizing Reimbursement in Today’s Fee for Service World Part 4: Cost Impact Mary Jean Mork, LCSW October 27, 2014 the support of the Maine Health Access Foundation

3. Objectives: Questions of Cost Participants will be able to:  Describe the present and future questions around cost of integrated services.  Identify a method of developing a proforma for the service  Have a link to research and information for future directions in understanding the cost impact of integrated services Disclaimer for the Series:  This information does not represent how a payer might respond to a claim  This information does not replace any regulatory information  Always seek information from your own agency consultants regarding any billing and coding practices

4. But really there are two different questions: What is the cost of integration? Or: What is the cost impact of integration?

5. The Question is Changing  The old question was:  Can behavioral health integration pay for itself?  The new question is:  What is the impact of behavioral health integration on health care costs?

6. Assumptions regarding Start-up Costs and Revenue Year 1- more investment than return  During the start-up period, the Behavioral Health Clinician (BHC) will not fill all available slots  Some of the work needed for development of successful integrated services is not billable under the current payment system. Year 2 and 3 - projected to bring in more revenue than expense

7. Understanding cost impact  Additional questions to ask:  How well integrated is the practice?  How long has practice been integrated?  How much integrated clinician time?  How well is integration being targeted?

8. What have others shown?  Intermountain Healthcare article 2010  Integration reduced ED utilization compared to non-integrated practices by 40-50%  Reiss-Brennan et al, Journal of Healthcare Management, 2010 March/April; 55(2): 97-114.  Collaborative care for depression  Initial cost of $580 per patient to implement the model led to decrease in total cost of care of $3300 on average over four years  Unutzer et al, Long-term cost effects of collaborative care for late- life depression. American Journal of Managed Care. 2008 Feb; 14(2):95-100.

9. Resources  For the old question:  SAMHSA Center for Integrated Health Solutions  Monograph on making the business case, with a spreadsheet that allows calculation of costs and revenues  Targets Community Health Centers but applicable to other types of practices  http://www.integration.samhsa.gov/resource/the- business-case-for-the-integration-of-behavioral- health-and-primary-care http://www.integration.samhsa.gov/resource/the- business-case-for-the-integration-of-behavioral- health-and-primary-care

10. Resources  For the new question:  Health Partners Total Cost of Care (TCOC) calculator  Describes a methodology for measuring total cost of care and resource use  Includes indexing method that allows comparison across sites  First TCOC methodology endorsed by National Quality Forum  https://www.healthpartners.com/public/tcoc/ https://www.healthpartners.com/public/tcoc/

11. Reimbursement Resources Medicare Links  http://www.cms.gov/Manuals/IOM/list.asp http://www.cms.gov/Manuals/IOM/list.asp  http://www.cms.gov/Transmittals/01_overview.asp http://www.cms.gov/Transmittals/01_overview.asp  Medicare Documentation Guidelines for Evaluation and Managements Services 95 & 97 http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp  NHIC http://www.medicarenhic.com/http://www.medicarenhic.com/  CMS National Correct Coding Initiative http://www.cms.gov/Medicare/Coding/NationalCorrectCodInit Ed/index.html/nationalcorrectcodinited Other  www.mehaf.org – Maine Health Access Foundation www.mehaf.org  www.ibhp.org – Integrated Behavioral Health Project www.ibhp.org  www.mainehealth.org/behavioralhealthintegration www.mainehealth.org/behavioralhealthintegration  www.thenationalcouncil.org – the National Council for Community Behavioral Healthcare www.thenationalcouncil.org

12. Contacts Mary Jean Mork, LCSW Program Director MaineHealth and Maine Behavioral Healthcare 110 Free St. Portland, Maine 04101 morkm@mmc.orgmorkm@mmc.org, 207-662-2490