To Share Savings, Providers Must Share Risk

John Commins, July 18, 2013

In our April Intelligence Report, the top challenge cited by leaders in pursuing a collaborative care model is "concerns about the ultimate cost savings." Members cited coding discrepancies, budget cuts, and convincing physicians to share the risks as barriers to incorporating a collaborative care model.

What do you see as the path to ensure cost savings in a collaborative care model, and what can leaders do to facilitate that?

Robert Ross, MD
Medical Director of Community Health Strategy

St. Charles Health System, St. Charles Medical Group
Bend, Ore.

On behavioral health: We have four clinics that are Tier 3 medical homes and in three of them we have fulltime behavioral health folks. For example, if a physician or actually any member of the team identifies a patient as being depressed they can get help not just in terms of medication but also using both psychotherapy or some type behavioral therapy and medications, which results in better outcomes for patients.

On coordinating payments: One of the problems we encounter is that you have to divide up the billing and costs for the separate services. Ultimately to have the many services, not just behavioral health but other things like pharmacy services, you could name a billion things, especially with people who have difficulty with access, so combining those and paying for them with some sort of global fee, probably capitation, would make it easier for everyone concerned and not just physicians. It eliminates costs for insurers as well in terms of verifying that services were delivered. Ultimately that is where we are heading, but that is a guess.

On coding shortcomings: There is a huge unexplored area of what is not coded and what things that patients have or experience that potentially are in the notes but not discerned by payers. The data we mine is determined by the provider codes and that is not a particularly accurate way of getting at people's problems because you code for what you are paid for and not necessarily for all the problems that are contained in a patient visit. It's a very complex problem.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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