Department of Population Health Sciences (Bao, Papp) and Department of Psychiatry (Bao), Weill Cornell Medical College, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Shern); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon); New York State Psychiatric Institute, New York City (Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor for this article.
Psychiatr Serv. 2021 Oct 1;72(10):1134-1138. doi: 10.1176/appi.ps.202000710. Epub 2021 Mar 4.
The authors aimed to identify prominent financing approaches for coordinated specialty care (CSC) of patients with first-episode psychosis, alignment or misalignment of such approaches with sustained CSC implementation, and CSC provider perspectives on ideal payment models.
Semistructured interviews were conducted with informants from CSC provider organizations. Purposeful sampling of CSC program directors, team leaders, and other administrators from a national e-mail Listserv was supplemented by snowball sampling via participant recommendations. Interview data from 19 CSC programs in 14 states were analyzed by using an integrated (inductive and deductive) approach to derive themes.
The results indicated that financing approaches to CSC were patchwork and highly varied. Three major sources of funding were cited: insurance billing (largely fee for service [FFS] to Medicaid and private insurance), set-aside funding from the federal Mental Health Block Grant (MHBG) program, and state funding. The findings revealed limited coverage and restrictive rules associated with FFS insurance billing that were misaligned with CSC implementation. The grant nature of MHBG and other public funding was seen as a threat to long-term CSC sustainability and deployment. CSC stakeholders endorsed a bundled-payment approach by public and private payers and supported tying payment to client outcomes to reflect CSC's recovery orientation.
Reliance on FFS insurance billing and public funding is likely to be unsustainable. Additionally, FFS billing is misaligned with CSC goals. Because of the diversity in CSC programs, populations, and existing funding mechanisms and rules, payer-provider collaboration will be essential in designing a bundled-payment model that meets local needs.
作者旨在确定针对首发精神病患者的协调专科护理（CSC）的突出融资方法，这些方法与持续 CSC 实施的一致性或不匹配，以及 CSC 提供者对理想支付模式的看法。
对来自 CSC 提供者组织的知情人进行半结构化访谈。通过国家电子邮件列表服务的 CSC 项目主任、团队领导和其他管理员进行有目的的抽样，并通过参与者推荐进行滚雪球抽样，以补充这种抽样。对来自 14 个州的 19 个 CSC 计划的访谈数据进行了分析，采用了一种综合（归纳和演绎）方法来得出主题。
结果表明，CSC 的融资方法是拼凑的，而且差异很大。有三个主要的资金来源：保险计费（主要是针对医疗补助和私人保险的按服务计费[FFS]）、联邦心理健康拨款计划（MHBG）的专项拨款，以及州拨款。研究结果表明，与 CSC 实施不一致的是，FFS 保险计费与有限的覆盖范围和限制性规则相关。MHBG 和其他公共资金的拨款性质被视为长期 CSC 可持续性和部署的威胁。CSC 利益相关者支持公共和私人支付者采用捆绑式支付方法，并支持将支付与客户结果挂钩，以反映 CSC 的康复方向。
依赖 FFS 保险计费和公共资金可能是不可持续的。此外，FFS 计费与 CSC 的目标不一致。由于 CSC 计划、人群和现有资金机制和规则的多样性，支付方-提供者的合作对于设计符合当地需求的捆绑式支付模式至关重要。
