Financing for Collaborative Care - A Narrative Review.
Financing for Collaborative Care - A Narrative Review.
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DOI：
10.1007/s40501-018-0150-4
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发表时间：
2018-09-01
影响因子：
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通讯作者：
Cerimele, Joseph M
中科院分区：
文献类型：
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作者：
Carlo, Andrew D;Unutzer, Jurgen;Cerimele, Joseph M
综述目的：协作治疗（CoCM）是一种基于证据的模式，用于治疗初级保健机构常见的精神健康状况。它的工作流程鼓励临床医生在与患者面对面接触之外进行系统的沟通，这在传统的按服务收费的报销环境中构成了财务挑战。最近的发现：组织采用了各种融资策略来促进CoCM的可持续性，包括外部赠款、与特定支付方签订的替代支付模式合同以及为CoCM的各个组成部分使用计费代码。近年来，医疗保险批准了CoCM的按服务收费、基于时间的计费代码，允许在面对面接触之外对患者进行的护理进行报销。越来越多的医疗补助计划和商业支付者也纷纷效仿，要么承认按服务付费的规定，要么签订合同，以替代支付模式进行报销。摘要：尽管仍存在重大挑战，但新颖的支付方法和保险公司之间的合作努力已帮助CoCM更接近财务可持续性。
PURPOSE OF REVIEW: Collaborative care (CoCM) is an evidence-based model for the treatment of common mental health conditions in the primary care setting. Its workflow encourages systematic communication among clinicians outside of face-to-face patient encounters, which has posed financial challenges in traditional fee-for-service reimbursement environments.RECENT FINDINGS: Organizations have employed various financing strategies to promote CoCM sustainability, including external grants, alternate payment model contracts with specific payers and the use of billing codes for individual components of CoCM. In recent years, Medicare approved fee-for-service, time-based billing codes for CoCM that allow for the reimbursement of patient care performed outside of face-to-face encounters. A growing number of Medicaid and commercial payers have followed suit, either recognizing the fee-for-service codes or contracting to reimburse in alternate payment models.SUMMARY: Although significant challenges remain, novel methods for payment and cooperative efforts among insurers have helped move CoCM closer to financial sustainability.