Are BHI and CCM Cost Effective Standards for Patient Care?

Behavioral health integration (BHI) is becoming increasingly important as physical health and mental health are being viewed as equally important to a patient’s overall health. However, in addition to examining the benefits of BHI, it might be important to take a look at the financial implications, as well.

BHI integrates both behavioral health with physical health at the primary care level by having patients assessed by both mental health professionals and primary care physicians. Within BHI are various integrated care models, with the collaborative care model (CCM) as the most common. CCM consists of care coordination, patient-centered treatment teams, the direct treatment of illness, evidence-based care, and population-based care. This approach to care is deeply tied to the Patient-Centered Medical Home model, as CCM features a large and collaborative treatment team that engages the patient during his/her treatment.

Although HBI has great potential benefits for patients, it comes with financial implications. According to the Institute for Clinical and Economic Review (ICER), integrated care approaches are exceptionally costly. Although ICER studies show that CCM is far more effective than traditional clinical care, CCM can be more expensive within the first six months to two years following implementation. According to the study, the added expense ranges from $20 to $3,900, depending on where the patient is and the disease with which he/she is diagnosed.

However, the study continues to state that despite the costs, the benefits of CCM may still be worth it.

“Findings from multiple studies across a variety of settings and populations suggest that the clinical improvements and costs ascribed to the CCM model of BHI [behavioral health integration] translate into cost-effectiveness ratios of $15,000-$80,000 per quality-adjusted life year (QALY), a range that falls within generally acceptable thresholds for cost-effectiveness,” ICER reports. However, ICER also notes that the studies on cost effectiveness are very narrow, and therefore are somewhat inconclusive.

Texas and Maine, however, managed to curb some of these costs by receiving grants, according to an article by Becky Hayes Boober and Rick Ybarra on HealthAffairs.org. Texas clinics received a three-year grant from the Hogg Foundation for Mental Health, allowing them to adopt the CCM and create resource guides, learning committees, and even a state conference on the topic. In partnership with the Department of Health and Human Services (HHS), Texas clinics have not only implemented CCM, but have also become leaders in integrated care strategy.

After receiving over $14 million in grants from the Maine Health Access Foundation (MeHAF), Maine was also able to implement CCM. The state has since applied such expansive CCM requirements that integrated care has become the norm across many of Maine’s public healthcare providers.

“…integrated care is a core requirement not only in Maine’s Patient-Centered Medical Homes, but also in its Health Homes, Behavioral Health Homes, and State Innovation Model,” the authors write. “As a result of these initiatives, more than 46 percent of Maine’s primary care practices provide some level of integrated care.”

Despite the benefits of CCM, the costliness can be hard to ignore. However, bearing in mind the ICER report, which states that the costs may be worth the benefits, as well as the cost-reducing grants both Maine and Texas have received, it is possible that CCM may become the new standard for patient care.