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Chronic Care Management | Behavioral Health

3 Steps to Integrate Behavioral Health with Chronic Disease Management

July 27th, 2021 | 7 min. read



Content Team

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When treating chronic illness, how often do you consider a patient’s mental health?

The two appear unrelated as if separated by the forms they take. It’s been shown, though, that there’s a link between them

Depression is common for people with diabetes, hypothyroidism, or psoriasis, for example. 

These, and other conditions, influence a patient’s state of mind and outlook on life. 

So, if a patient feels hopeless or unmotivated, is treatment more difficult? And if so, how does this affect the efficacy rate of medical practice? 

About 70% of Medicare beneficiaries live with two or more chronic ailments. And an estimated 20% of enrollees suffer a behavioral health issue.

These statistics, combined with anecdotal evidence, present an intersection. At it, there’s a challenge, and there’s an opportunity. 

At ThoroughCare, we help more than 600 clinics and physician practices with our intuitive care coordination software. We simplify the administrative process for several care management programs, promoting efficiency. 

Pairing Chronic Care Management (CCM) with a lesser-known Medicare program called Behavioral Health Integration (BHI) is one example.  

In this article, we’ll review the specifics of each program, how they can intersect and how care management software, like ThoroughCare, can accommodate a holistic approach to treatment.

With this information, you’ll know whether it makes sense for your practice to integrate BHI and CCM.

What is Behavioral Health Integration (BHI)?

BHI helps integrate physical and mental health treatment

The program is fulfilled remotely each month. Any Medicare Part B beneficiary is eligible. They present at least one behavioral condition and consent to enrollment. 

It is primarily managed by the patient’s physician or care manager. A third-party psychiatric consultant or therapist may provide additional services, though. 

BHI represents a shift in healthcare, toward holism. The goal is to improve a person’s health through one, efficient mechanism. 

It is a monthly service based upon several core elements. These should include:

For the patient, Medicare Part B will cover up to 80% of the cost. Other insurances, such as Medicaid or private companies, may also cover this cost, too.

What is Chronic Care Management (CCM)?

CCM is care coordination for chronic illnesses. 

Like BHI, it is implemented monthly outside a regular doctor’s appointment, while the patient is at home. Medicare Part B beneficiaries are eligible.

To enroll, a patient must have two or more chronic conditions expected to last at least 12 months. These conditions must pose a significant risk of death, acute decompensation, or decline — as determined by the provider. 

As the doctor, you must note such conditions at least 12 months before CCM enrollment. Most likely during a patient appointment. 

Again, like BHI, this program operates on a monthly schedule. It should include:

  • The initial creation of a patient care plan
  • Phone calls and secure communication with the patient
  • Coordination with other clinicians, facilities, community resources, and caregivers
  • Ongoing assessment of the patient’s medical and psychosocial needs
  • Ensure timely receipt of all recommended preventive care services
  • Medication reconciliation with a review of adherence and potential interaction

Medicare Part B will also cover up to 80% of the cost for the patient, as will other insurances.

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How Can Behavioral Health Integration (BHI) Improve Treatment of Chronic Illness?

The intended purpose of BHI shows its opportunity.

By creating the program, Medicare has made a statement. It is encouraging physicians to weave mental health treatment into the greater fabric of wellness. 

It is also diminishing the stigma tied to conditions like depression or anxiety. 

People often ignore treatment for, let alone acknowledge, these conditions due to fear of judgment. More than half of all United States citizens with mental illnesses forgo help. 

If you’re already speaking to your patients about treatment for chronic conditions, or have enrolled them in CCM services, why not use the opportunity to address mental health? 

1. Make The Patient Aware of Behavioral Health Integration (BHI) and Promote Enrollment

So, as a doctor, what role do you play in this conversation?

If you’re already seeing patients 65 years of age or older, whether in an Annual Wellness Visit (AWV), physical examination, or a routine check-up, start a dialogue. Especially if the individual lives with chronic conditions.

This exchange can highlight the intersection of these diseases with behavioral health. It can introduce the patient to BHI as a Medicare benefit. 

Granted, the patient may take this conversation with a grain of salt. As the trusted care provider, though, you can greatly influence their health considerations. 

It is key to make the patient comfortable when discussing any mental health challenges they face. Just as they would discuss anything else with you, remind them that, as a doctor, you’re open to their concerns. 

As well, highlight for them some of the statistics or evidence shown above in this article. 

Help the patient understand that behavioral health is just as real, and in need of attention, as a physical ailment. 

2. Effectively Focus Behavioral Health and Chronic Care Resources

You can manage a patient’s mental ailments through CCM. A provider can declare depression, anxiety, or obsessive-compulsive disorder, among others, as chronic conditions. 

But why dilute the focus of that program? 

Leave CCM for the physical issues that appropriately fit the label.

An additional benefit of BHI, for doctors and patients alike, is it isolates specific mental health concerns and designates particular attention to them. 

It takes them seriously — in their own right. Not lump them within a broad category.   

For the patient, this equates to specialized care and pointed discussion about the reality of whatever it is they’re dealing with. 

For the provider, differentiating between CCM and BHI, or pairing them together, effectively allocates resources. 

3. Seize The Benefits

By making an effort, you and the patient are due the reward.

For the Patient

Many chronic conditions take root in lifestyle. Poor behavioral health can compound them, digging a deeper ditch.

With BHI, patients can more easily address and manage what ails them. On both fronts. 

And for patients who are usually averse to discussions or treatment of mental health, BHI can serve as an introduction. 

Patients may be more comfortable working with their primary doctor than with a therapist

BHI creates an environment of access and support.

For the Provider

First, there’s the added layer of expertise your practice stands to gain. 

While you are not necessarily an authority on mental health, you can use BHI as an opportunity to collaborate with a professional who is

Making this connection will only make your practice more valuable in its ability to treat its patients

As well, BHI can be combined with other Medicare preventive health programs, such as CCM, to boost revenue. 

BHI will reimburse, on average, $54 per patient per month for 20 minutes of non-face-to-face services. 

In combination with CCM, which bills at an average of $61 per month for 20 minutes of non-face-to-face interaction, the average single-doctor practice can generate about $11,500 per month with 100 patients enrolled in both

Implement BHI for Value-Based Care Success

Value-based care revolves around general quality performance metrics, such as patient engagement, treatment effectiveness, and clinical efficiency. But it presents you and other providers with a challenge, in that you’re asked to meet these expectations without a streamlined way to do so.

Missing the mark could mean that your practice fails to maximize reimbursement opportunities. 

BHI can help your practice meet the performance metrics underlying value-based care. The program can also help your practice adapt to reimbursement challenges, and drive revenue. Learn more about how BHI can help your practice specifically implement value-based care

Digital software solutions are available to help your practice embrace integrated, coordinated care through BHI. At ThoroughCare, we’ve designed our care coordination software for easy clinical use with an intuitive interface that allows you and your team to engage patients through multiple care management programs.

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