Blue Cross Blue Shield of Michigan (BCBSM) recently announced the names of its Patient-Centered Medical Home (PCMH) designees – many receiving designation renewals, but others being PCMH designated for the first time. From my vantage point, these practices, whether multiple-year designees or newbies, represent the best of primary care and affirm the effectiveness of a healthcare approach that puts the patient in partnership with the physician or advanced care provider and their team to optimize outcomes in physical and mental health. I again must give recognition to my friend Tom Simmer, MD, who had the foresight to launch the PCMH practice program through the Physician Group Incentive Program (PGIP; now known as value partnerships) when he was the CMO at BCBSM.
I mention the PCMH program because, coincident with that announcement, BCBSM also
introduced the use of the Collaborative Care Model (CoCM) for physician group members. CoCM brings together both physical and behavioral health providers to a primary care setting to offer integrated care. I’ve long advocated for this model and have seen it in action at Judson Center Health, our joint venture integrated primary care clinic in Warren where our organization provides the clinical staff and Judson Center provides behavioral health. We also have a few member practices who have adopted the CoCM model and appreciate access to a psychiatrist who can review medications and provide feedback on symptom management.
Admittedly, there are downsides to the CoCM model. First, it can be time consuming to get off the ground. The PCP must identify and contract with a psychiatrist for behavioral health services and determine where and how those services will be provided. Then the PCP needs to negotiate a fee the psychiatric is willing to accept. In a twist, payment for the services rendered by the psychiatrist is provided by the primary care physician. There is one amount reimbursed by the payer to the primary care physician who then, based on the agreed compensation, pays the psychiatrist. Perhaps equally challenging is the fact that the CoCM does not include psychologists, who are more accessible than psychiatrists but cannot prescribe medication. In certain states, psychologists have prescribing licenses that are obtained after they have completed specialized pharmacological learning programs. There are just a select number of medications that those psychologists can prescribe. Adding psychologists with prescribing capabilities would also ease some of the backlog patients experience.
Like many approaches to whole-person care, the Collaborative Care Model is not without its challenges. Yet, it does represent movement towards full acceptance – and payment – for integrated care. When the PCMH model was first announced, it was met with skepticism by some. But more than 15 years later, it continues to evolve and prove a viable and sustainable approach to primary care. With tweaking and a plan, do, study, act (PDSA) approach that seeks to address challenges head on and in a timely manner, I’m confident that BCBSM’s adoption of the CoCM model is going to take us to the next generation of integrated, whole person care.