The Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) demonstration, a Colorado project that integrated behavioral health services into primary care settings, saved about $1.08 million in net cost savings for Medicare, Medicaid and dual-eligible patients, according to a new report in Translational Behavioral Medicine.
The report said the savings came from fewer hospitalizations and other downstream utilization.
Integrating behavioral health into primary care and creating a non-fee-for-service payment program can lead to “significant cost savings for public payers, which could have implications on future delivery and payment work in public programs,” the report added.
Mental health parity remains an issue in healthcare. A 2017 study found people with serious psychological distress are more likely to lack money for medication and healthcare as well as experience more delays in care than adults without it.
Integrating behavioral health services into primary care offices is seen as a way to improve and better coordinate care, but there are concerns with properly funding behavioral services in that setting. However, the report from Colorado shows that using risk-adjusted payments that focus on improving quality is one way to create an integrated program that can save money.
SHAPE involved six practices in the Denver area and payer Rocky Mountain Health Plans. Each practice had at least one on-site behavioral health provider.
Three practices received SHAPE payments. These were global payments for behavioral health services that included risk-adjustment for patients with greater needs that required more support from providers. There were also incentives baked into the payments for quality improvements in patient health outcomes and shared risk and accountability between the practices and payer. The other three practices received traditional fee-for-service payments.
Researchers analyzed claims data for more than 9,000 Medicare, Medicaid and dual-eligible patients during the 18-month project. They found success in cost savings and a possible model for others to replicate.
A 2014 Commonwealth Fund article pointed to payment programs like SHAPE as a way to remove barriers that restrict behavioral health integration.
"While there are still significant barriers to integrating behavioral health and primary care, there are also several forces encouraging it, among them: new payment policies, including models that begin to hold providers accountable for controlling overall costs and demonstration programs led by Medicaid and Medicare.
Mental health parity laws that prevent insurers from placing greater financial requirements (e.g., copayments) or treatment restrictions on mental health or substance abuse care than they do on medical care also help, as does the fact that private health plans sold through the Affordable Care Act’s health marketplaces must now include behavioral health benefits," co-authors Sarah Klein and Martha Hostetter wrote.