Skip to main content
SpringerLink
Log in

Payment Barriers and Potential Solutions to Psychiatric Service Delivery in the Medical Setting

  • Chapter
  • First Online:
Integrated Care in Psychiatry

  • 1009 Accesses

Abstract

This chapter explores the question of payment barriers and economic challenges for psychiatric service delivery within the medical setting. We first summarize how payments for psychiatric services developed and are treated differently than other medical services. Integrated care and patient-centered medical homes are shifting American health care from a fee-for-service model to a complex model of global payment, risk sharing, and incentives for quality and coordinated care. Psychiatry and behavioral health will play an essential role in consultation, care management, and coordination with primary care partners. Integrated behavioral health care models can be safer, better, and ultimately less expensive. We provide suggestions on how to address the challenge of convincing the health care system to integrate the payment for psychiatric and other behavioral services.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Borson S, Liptzin B, Nininger J, Rabins P. Psychiatry and the nursing home. Am J Psychiatry. 1987;144:1412–8.

    CAS  PubMed  Google Scholar 

  2. Frank RG, Goldman HH, McGuire TG. Will parity in coverage result in better mental health care? New Engl J Med. 2001;345:1701–4.

    Article  CAS  PubMed  Google Scholar 

  3. Summergrad P, Hackett TP. Alan Gregg and the rise of general hospital psychiatry. Gen Hosp Psychiatry. 1987;9:439–45.

    Article  CAS  PubMed  Google Scholar 

  4. Bennett MJ. The greening of the HMO: implications for prepaid psychiatry. Am J Psychiatry. 1988;145:1544–9.

    CAS  PubMed  Google Scholar 

  5. Brady J, Krizay J. Utilization and coverage of mental health services in health maintenance organizations. Am J Psychiatry. 1985;142:744–6.

    CAS  PubMed  Google Scholar 

  6. Glasser M. The history of managed care and the role of the child and adolescent psychiatrist. Child Adolesc Psych Clin N Am. 2010;19:63–74.

    Article  Google Scholar 

  7. Liptzin B, Gottlieb G, Summergrad P. The future of psychiatric services in general hospitals. Am J Psychiatry. 2007;164:1468–72.

    Article  PubMed  Google Scholar 

  8. Liptzin B, Meyer RE. Financing academic departments of psychiatry. Acad Psychiatry. 2011;353:96–100.

    Article  Google Scholar 

  9. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.

    Google Scholar 

  10. Institute of Medicine. Improving the quality of healthcare for mental and substance-use conditions: quality chasm series. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  11. Druss BG, Mauer BJ. Health care reform and care at the behavioral health-primary care interface. Psychiatr Serv. 2010;61:1087–92.

    Article  PubMed  Google Scholar 

  12. Barry CL, Huskamp HA. Moving beyond parity – mental health and addiction care under the ACA. NEJM. 2011;365:973–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, et al. Prevalence and treatment of mental disorders, 1990-2003. NEJM. 2005;352:2515–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States. Arch Gen Psychiatry. 2005;62:629–40.

    Article  PubMed  Google Scholar 

  15. Kathol RG, Kunkel EJS, Weiner JS, McCarron RM, Worley LL, Yates WR, et al. Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance use disorder interface. Psychosomatics. 2009;50:93–107.

    Article  PubMed  Google Scholar 

  16. Katon W, Unutzer J, Wells K, Jones L. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. Gen Hosp Psychiatry. 2010;32:456–64.

    Article  PubMed  Google Scholar 

  17. Unutzer J, Katon WJ, Fan MY, Schoenbaum MC, Lin EH, Della Penna RD, et al. Long term cost effects of collaborative care for late-life depression. Am J Managed Care. 2008;14:95–100.

    Google Scholar 

  18. Community Preventive Services Task Force. Recommendation from the Community Preventive Services Task Force for Use of Collaborative Care for the Management of Depressive Disorders. Am J Prev Med. 2012;42:521–4.

    Article  Google Scholar 

  19. Thota AM, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012;42:525–38.

    Article  PubMed  Google Scholar 

  20. Katon W, Russo J, Lin EH, Schmittdiel J, Ciechanowski P, Ludman E, et al. Cost-effectiveness of a multicondition collaborative care intervention. Arch Gen Psychiatry. 2012;69:506–14.

    Article  PubMed  Google Scholar 

  21. Jacob V, Chattopadhyay SK, Sipe TA, Thota AB, Byard GJ, Chapman DP, et al. Economics of collaborative care for management of depressive disorders: a community guide systematic review. Am J Prev Med. 2012;42:539–49.

    Article  PubMed  Google Scholar 

  22. Katon WJ, Lin EHB, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, et al. Collaborative care for patients with depression and chronic illnesses. N Eng J Med. 2010;363: 2611–20.

    Article  CAS  Google Scholar 

  23. Kathol RG, Butler M, McAlpine DD, Kane RL. Barriers to physical and mental condition integrated service delivery. Psychosom Med. 2010;72:511–8.

    Article  PubMed  Google Scholar 

  24. Solberg LI, Glasgow RE, Unutzer J, Jaeckels N, Oftedahl G, Beck A, et al. Partnership research: a practical trial design for evaluation of a natural experiment to improve depression care. Med Care. 2010;48:576–82.

    Article  PubMed  Google Scholar 

  25. Reiss-Brennan B, Briot PC, Savitz LA, Cannon W, Staheli R. Cost and quality of Intermountain’s mental health integration program. J Healthcare Manag. 2010;55:97–113.

    Google Scholar 

  26. Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database Syst Rev. 2011; (9):CD001025.

  27. Sarvet B, Gold J, Bostic JQ, Masek BJ, Prince JB, Jeffers-Terry M, et al. Improving access to mental health care for children: the Massachusetts child psychiatry access project. Pediatrics. 2010;126:1191–200.

    Article  PubMed  Google Scholar 

  28. Keller D, Sarvet B. Is there a psychiatrist in the house? Integrating child psychiatry into the pediatric medical home. J Am Acad Child Adol Psychiatry. 2013;52:3–5.

    Article  Google Scholar 

  29. Amiel JM, Pincus HA. The medical home model: new opportunities for psychiatric services in the United States. Curr Opin Psychiatry. 2011;24:562–8.

    PubMed  Google Scholar 

  30. Harkness E, Bower PJ. On site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers. Cochrane Database Syst Rev. 2009; (1): CD000532.

    Google Scholar 

  31. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27:759–69.

    Article  Google Scholar 

  32. Katon W, Unutzer J. Consultation psychiatry in the medical home and accountable care organizations: achieving the triple aim. Gen Hosp Psychiatry. 2011;33:305–10.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Liptzin B. Quality improvement, pay for performance, and “Outcomes Measurement”: what makes sense? Psychiatr Serv. 2009;60:108–11.

    Article  PubMed  Google Scholar 

  34. Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011; (9): CD008451.

  35. Unutzer J, Chan YF, Hafer E, Knaster J, Shields A, Powers D, et al. Quality improvement with pay-for-performance incentives in integrated behavioral health care. Am J Public Health. 2012;102:e41–5.

    Article  PubMed  Google Scholar 

  36. Lewis V, Larson B, McClurg A, Boswell R, Fisher E. The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles. Health Aff. 2012;31:1777–85.

    Article  Google Scholar 

  37. Kathol RG, Lattimer C, Gold G, Perez R, Gutteridge D. Creating clinical and economic “wins” through integrated case management. Prof Case Manag. 2011;16:290–8.

    Article  PubMed  Google Scholar 

  38. Hunkeler EM, Hargreaves WA, Fireman B, Terdiman J, Meresman JF, Porterfield Y, et al. A web-delivered care management and patient self-management program for recurrent depression: a randomized trial. Psychiatr Serv. 2012;63:1063–71.

    Article  PubMed  Google Scholar 

  39. Scharf DM, Eberhart NK, Schmidt N, Vaughan CA, Dutta T, Pincus HA, et al. Integrating primary care into community behavioral health settings: programs and early implementation experiences. Psychiatr Serv. 2013;64(7):660–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Adult Outpatient Psychiatry, Department of Psychiatry, Baystate Medical Center, Tufts University School of Medicine, 3300 Main Street, Suite 3D, Springfield, MA, 01199, USA

    Stuart A. Anfang M.D.

  2. Department of Psychiatry, Baystate Medical Center, Springfield, MA, USA

    Benjamin Liptzin M.D.

Authors
  1. Stuart A. Anfang M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Liptzin M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stuart A. Anfang M.D. .

Editor information

Editors and Affiliations

  1. School of Medicine, Tufts University, Boston, Massachusetts, USA

    Paul Summergrad

  2. Cartesian Solutions, Inc., University of Minnesota, Burnsville, Minnesota, USA

    Roger G. Kathol

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Anfang, S.A., Liptzin, B. (2014). Payment Barriers and Potential Solutions to Psychiatric Service Delivery in the Medical Setting. In: Summergrad, P., Kathol, R. (eds) Integrated Care in Psychiatry. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0688-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0688-8_4

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0687-1

  • Online ISBN: 978-1-4939-0688-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation