Collaborative Care
What is Collaborative Care?
As the newest offering under Mindset, One Medical’s suite of behavioral health services, Collaborative Care offers members in-network, virtual behavioral health care tailored to patient needs based on an evidence-based care model. The program relies on a team-based targeted approach to treatment rooted in exceptional primary care and aimed at achieving symptom relief and improving functional status.
Collaborative Care is currently available by PCP referral only and involves matching patients with a Care Manager who coordinates with the PCP, psychiatric consultant and therapist as relevant to ensure the patient gets the care they need. Through shared decision-making, the on-staff care team and patient come up with a 6- to 12-month care plan that is tailored to the patient needs, integrating a range of services offered under the Mindset umbrella as well as referrals outside of One Medical if needed. Care plans often include a combination of goal-focused therapy, self-help, skills training, coaching and medication management as needed but plans don’t necessarily have to include therapy. Once symptoms subside and the patient graduates from the program, our staff reaches out for regular follow ups for maintenance.
As of today (July 2024), Collaborative Care is available in the SF Bay Area and Seattle with a plan to expand to San Diego and DC/DMV in Fall ‘24 with additional MSAs to follow.
What is the Virtual Therapy program?
Virtual Therapy is part of One Medical’s Mindset program and is an enterprise buy-up option providing additional behavioral health support nationwide by licensed mental health providers. and certified behavioral health coaches.
What is Impact?
Impact by One Medical combines longitudinal high-touch care and health navigation with an integrated technology platform to help patients manage their chronic conditions and avoid the onset of new ones. From diabetes to hypertension, One Medical’s team-based approach tackles chronic care management — all in one place.
The core features of the program include a specialized care team that coordinates care, a personalized care plan based on comprehensive screening and shared decision-making, ongoing check-ins and targeted interventions, lifestyle coaching and educational services.
What is Care Navigation>
The Care Navigation team partners with complex patients that need additional support navigating their health journey by removing barriers to care. The team specializes in multi-disciplinary care coordination to improve the wellbeing of One Medical’s complex patients.
What is Treat Me Now?
Treat Me Now is a way to get fast, convenient care from the One Medical Virtual Medical Team by answering a quick questionnaire in the One Medical App (available for Android and iOS).
The member answers a few quick questions about their concern, sometimes will add a photo (for example, skin concerns) and then in many cases, VMT can prescribe Rx, or route to the appropriate next step based on the survey.
How does a patient access Collaborative Care?
Collaborative Care is currently available by PCP referral.
Who is eligible for the Virtual Therapy program?
Once an employer sponsors the ONEM membership and purchases virtual Therapy for their population then those employees can access Virtual Therapy. Eligible members include adults as well as kids and teens, thanks to our partnership with Bend Health.
What areas does Impact support patients with?
Impact supports members with cardiometabolic conditions, which include the following:
Diabetes (including pre-diabetes and gestational diabetes)
Hypertension
Obesity / overweight
Fatty liver disease
Lipid management
Heart disease
Who qualifies for care navigation?
Complex Care is defined as a member who needs intensive primary care support and a bridge with specialty care and to their PCP.
Patients 18+ years old who are experiencing barriers to care, and/or facing complex care challenges, exacerbated by difficulty self-managing, AND would benefit from longitudinal, relationship-based support from a Care Navigator: Examples include:
Active Cancer Diagnosis
New or Uncontrolled Diagnosis
Multiple Diagnoses Care Coordination
Wellness Coaching/Short-Term Behavior Change:(must have 2 chronic conditions)
Hospital Discharge Needing Follow-up (HH, postpartum care, etc.):
ER Recurrent Avoidable Use
External Social Support Services
Frail and failing elder care(not VBC)
Unstable Diabetes Type 1
Hospice/Assisted Living Resources
Medication adherence barriers
What conditions can be addressed via Treat Me Now?
COVID, Cold, and Flu
Urinary Tract Infection (UTI, bladder infection)
Skin Issue
Sexual Health Screening (STI)
Yeast Infection
Cold Sore
Sinus Infection
Seasonal Allergies (Hay Fever)
Nausea, Vomiting, Diarrhea (stomach flu, traveler’s diarrhea, food poisoning)
Birth Control and Emergency Contraception
Eye Redness (pink eye)
Laryngitis (hoarse voice, lost voice)
Acid Reflux
Acne
Acute Gout Attack
Altitude sickness prevention
Athlete’s Foot
Bug Bites and Stings
Dandruff
Eczema
Erectile Dysfunction
Facial Wrinkles and Fine lines
Male-Pattern Hair Loss
Motion Sickness Prevention
New Medication Prescription
Rosacea
Shingles
Tick Bite
Toenail Fungus
Other Health Concern
Members may inquire about any concern and VMT will address or route appropriately
As it relates to geographic restrictions and age, who is eligible to partake in Collaborative Care?
As of today, members in the SF Bay Area, San Diego, Seattle, and DMV can access Collaborative Care via PCP referral. Qualified members include adults as well as kids and teens, thanks to our partnership with Bend Health.
Explain the billing options for Virtual Therapy
Virtual Therapy is sponsored by the employer at no cost to the employees. There's a one time implementation fee of $5,000 and services are billed monthly either directly to the employer or through claims.
What restrictions are there for Impact?
Chronic care management billing codes require our members to have 2+ chronic conditions for services to be covered under insurance.
While Impact is available in our nearsite markets nationwide(See the “Who is eligible” section above for more clarity on availability).
What conditions can be addressed via Care Navigation?
The Scope of Care Navigation is as follows:
Basic lifestyle recommendations (stress mgmt techniques, healthy eating, sleep hygiene, etc.)
Health coaching / behavior change counseling
Monitor chronic care metrics (BP, repeated labs, med adherence, BG)
Empathetic listening and supportive advice with clear goals and timelines established
Certain assessments (wellness inventory, GAD-7, PHQ-9)
Creating orders for home health, hospice, DME, transportation, social work, or other referrals discussed with the PCP
Who responds to Treat Me Now inquiries?
One Medical’s in-house virtual medical team (VMT) responds to Treat Me Now inquiries.
How is Collaborative Care billed?
Since Collaborative Care is in-network, all related visits/treatment are billed to insurance.
Intake: The PCP intake and initial diagnostic evaluation with a therapist are billed according to PCP or Therapy CPT codes under the PCP or Therapist’s respective NPI.
Integrated BH Services: All behavioral health services that members receive as part of their Collaborative Care plan are billed to insurance according to standard billing practices. The clinically-trained Care Manager’s time is billed on a monthly basis under the PCP NPI.
BH Therapy: Visits with a therapist are billed per visit using Therapy CPT codes under the therapist’s NPI.
24/7 Crisis Line: The crisis line is included as part of virtual services at no extra cost.
What are the limitations of the Virtual Therapy program?
Virtual Therapy is only available through an employer sponsored membership.
While we can provide virtual therapy in a non-MSA, it is preferred that the client have at least 1k EEs.
Additionally, ONEM’s behavioral health staff are unable to write prescriptions, which can seem limiting but it reinforces the collaboration between the coach/therapist and the patients’ PCP. Lastly, if the employer is paying through claims then the employee has to be on the employer’s health plan and not on their spouses.
How is Impact paid for?
All of the services delivered through the Impact program are billed by chronic care management CPT codes (which are based on time spent with providers) at the end of the month. The minutes are entered (self-reported) in the documentation by the providers.
Average CPT rates vary considerably by region, so the ultimate amount billed is dependent upon a number of factors including geographical location and benefit selection (plan type and carrier).
Since there is considerable variance by region, insurance coverage, and other factors, we recommend discussing pricing specifics once the details of each unique client are known.
Explain how Collaborative Care is billed
Care Navigation relationships and services provided are at no cost most commonly. In some cases, we are experimenting with billing for chronic care but these codes do not reflect back to the patient at this time.
What is the standard response time?
Treat Me Now is often the fastest (2-4 hour turnaround time) and most private way (no need for a call or email) for patients to request help with their routine medical issues.
How is success defined in the program?
Clinical success is defined by the percentage of members reporting a clinically significant reduction in GAD-7 and PHQ-9 anxiety and depression scores after participating in Collaborative Care.
Additionally, programmatic success includes member engagement, graduation from the program, a high NPS and meeting targets for members, visits and financial growth.
How success defined for the program?
Based on historical data, we expect patients to graduate coaching in 4-6 sessions and therapy in 8-12 but there are no limits on the number of visits a patient can have.
83% of all members are screened for depression annually helping us intervene early during Annual Wellness Visits (Live Well).
We’ve seen a reduction in depression scores by 56% and a 52% reduction in anxiety scores - where 50% and 20% respectively are clinically significant.
For the overall program, we typically see that an employer’s utilization is around 10%. While it may seem low it is not because the program isn’t impactful but we find that those with escalated needs are using the services because 80% of behavioral health needs can be addressed in the PCP setting.
How is success defined in the program?
Success is defined by improvement in engagement with demonstrated results in reduction of A1c levels, weight and LDL.
What are the limitations of the Care Navigation program?
The Care Navigation team is unable to support patients younger than 18 years old, as well as, OM Now patients. The team is also quite small compared to the number of patients they support, therefore, only internal provider referrals are accepted (no external marketing).
Additionally, Care Navigators cannot provide:
Therapy sessions
Mental health monitoring/check-ins
Housing assistance
Legal advice or services
Urgent psychosocial monitoring
Acute Mental Health or Addiction intervention
What are the limitations of Treat Me Now?
Due to the nature of Treat me Now, sometimes needs that require in-person attention will necessitate an in-person visit.