What is the Collaborative Care Model (CoCM)?
Collaborative Care Model (CoCM) is an integrated modality that provides patients with medical and behavioral health care in a primary care setting. An increasing number of primary care settings are incorporating behavioral health services. Benefits of CoCM include better patient outcomes, improved patient and provider satisfaction, and reduction in health care costs. In addition, using CoCM may reduce health disparities in access to behavioral health. Most payors in North Carolina already cover the CoCM billing codes.
The Collaborative Care Model leverages a team-based, interdisciplinary and systematic approach to screen, diagnose, treat, and provide follow-up care. The CoCM includes:
• A team made up of a Primary Care Provider (PCP) who leads the team, a Behavioral Health Care Manager (BHCM), and a Psychiatric Consultant;
• care coordination and management;
• regular/proactive monitoring and treatment using validated clinical rating scales;
• and systematic psychiatric caseload reviews and consultation for patients who do not show clinical improvement.
What Resources are Needed for the Collaborative Care Model?
Below is a list of staff and resources needed to implement CoCM; please note this is not a complete list.
• A Behavioral Health Care Manager (BHCM) who is full-time or shared, employed or contracted, onsite or virtual;
• A contracted or employed Psychiatric Consultant (2-4 hours/week), onsite or virtual with protected time for the Primary Care Provider (PCP) and BHCM to review the caseload;
• Protected time for PCPs to periodically communicate and participate in the care coordination;
• A shared data registry that tracks depression scores, anxiety scores and progress in treatment for enrolled patients;
• Systematic screening protocols.
What is NC AHEC’s Role with Collaborative Care Model (CoCM)?
The North Carolina Department of Health and Human Services, Division of Health Benefits (DHB) has partnered with NC AHEC to provide educational and practice-based support to primary care practices interested in implementing the Collaborative Care Model. This includes coaching on workflows and billing/coding, registry implementation, and continuing education programs.
NC AHEC will offer CoCM virtual learning opportunities, including:
(1) Education Modules, designed for providers interested in learning about the CoCM. Modules currently available on demand include:
Module 1: Collaborative Care Model (CoCM) Rationale and Evidence
Module 2: Laying the Foundation for Collaborative Care Through Practice Transformation
Module 3: Putting Collaborative Care Principles into Practice: Planning for Clinical Practice Change
Module 4: Collaborative Care Management for Primary Care Providers
Module 5: The Role of the Psychiatric Consultant in the Collaborative Care Model
Module 6: Billing the Codes and the General Business Model for Collaborative Care
Module 7: Brief Therapeutic Interventions
Module 8: Best Practices for Collaborative Care Management Behavioral Health Care Manager
Module 9: Behavioral Health Care Manager (BHCM) Best Practices
Module 10: Best Practices in Pediatric Collaborative Care
Module 11: Primary Care Provider Engagement
Module 12: Collaborative Care Model in Substance Use Disorders
Module 13: Diversity, Equity, and Inclusion in Collaborative Care: A Review of the Evidence in Minority Populations and Next Steps
To register for and access the modules listed above, click the blue button below.
(2) Learning Collaboratives, designed for providers actively engaged with NC AHEC coaches to implement the CoCM within their practices.
What Other Groups Support CoCM?
Other agencies and associations that support this endeavor include:
• The NC Academy of Family Physicians, NC Pediatric Society, and NC Medical Society support this endeavor.
• Community Care of North Carolina (CCNC) provides access to an enhanced version of the AIMS Caseload Tracker registry for up to three years for qualifying practices starting in the fall of 2022.
• The NC Psychiatric Association and NC PAL are supplying adult and pediatric psychiatrists to partner with interested practices. NC PAL pediatric psychiatrists will be made available at no cost for up to ten practices.
For more information, contact NC AHEC Practice Support at firstname.lastname@example.org or NC Medicaid at NC DHHS: Medical Assistance.
Meet Our Team
We all share the responsibility of ensuring quality health care is delivered to the citizens of North Carolina. Collaboration is key to achieving this goal. We appreciate our partners for their support of NC AHEC Practice Support.