How to reimburse physicians for such services remains a challenge. "We've struggled with this for the past five years. The problem has been the mismatch between the cost of the program—-paid for by the practice—and the benefit, which only partly accrues to an insurance company in the short to intermediate term, and partly accrues to the employer," Kinkman says.
A variety of "mix-and match" approaches are emerging, he says, but the best solution will come from global reimbursement (vs. fee-for-service) for primary care practices "that implement the patient-centered medical home and use tools like we have developed here to support care for chronic illness.," he says. But, he adds, there is a lot of work to do to build public support for that type of change in primary care.
The approach isn't limited to depression, he says, It can also serve as a model for treating other types of chronic conditions, he says.
The paper addresses this explicitly: "All methods developed for this project were intended to be transportable to disease management programs for other chronic health conditions. By integrating care management tools and personnel across several related conditions (e.g., depression, diabetes, and heart failure), it should be possible to achieve the scalability that will make integrated disease management feasible in the patient-centered medical home." The findings "should provide valuable guidance to the development of chronic care management programs for the primary care setting."
A pilot is now underway. "We are just now extending this program into community primary care settings, and find—no surprise—that the primary care clinicians and practices are very open to extending the program to include patients with depression plus other conditions as the first trial of patient-centered chronic disease support," he said.