Integrating mental health care into primary care doesn’t add to costs, a Penn-IBX study found

Research by Penn Medicine and Independence Blue Cross has found that a new model for providing and paying for mental health services at primary care practices doesn’t increase overall costs for insurers.

The two institutions have been studying a new billing code created to help health-care providers address mental health issues since 2018. Their work previously showed that linking primary care and mental health services increased the number of patients receiving needed behavioral health care and led to mental health improvements. Researchers have long found strong ties between physical and mental health.

“Most people with mental health needs don’t find themselves at specialty mental health programs — either because they are hard to access, or it’s just not an accessible setting for them, or because of stigma,” said Courtney Wolk, an assistant professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine.

In 2017, Medicare created billing codes that allow primary care doctors to get paid for the time they spend collaborating with mental health and other professionals. Private insurers subsequently adopted those billing codes.

The codes also pay for the services of a behavioral health care manager in the primary care office and for consultations with a psychiatric consultant, said Matthew Press, a Penn primary care physician who led the development of collaborative care at Penn.

New research published Friday in the American Journal of Managed Care by Press, Wolk and their collaborators looked at how supplementing primary care with mental health services affected overall medical spending. Patients with mild to moderate depression, anxiety, or alcohol misuse are eligible for the program.

The model is not for people with more serious forms of mental illness, such as schizophrenia or major depression.

Researchers compared spending for two groups of patients insured by Independence Blue Cross, who were treated at eight Penn Medicine primary care offices over the course of a year. They found that the cost of providing care for the group that received the additional mental health services was $29.35 less each month, per patient, than for a group of comparable patients who did not receive the extra services.

“Even if you spend a little bit more money on collaborative care, you’re saving that money within a few months down the road. At worst, you’re breaking even,” Press said, referring to the financial results from the insurer’s perspective.

Start-up costs are the main financial challenge for primary care offices, which typically needed at least three months to build up a full patient schedule for the behavioral health care manager, who is typically a social worker licensed to provide mental health services.

“Once we get ramped up to a full panel, we’re pretty close to break even,” Press said.