Funding mechanisms for depression care management: opportunities and challenges.
OBJECTIVE
Inconsistent third-party reimbursement for depression care management is a significant economic barrier to the utilization and sustainability of the chronic illness care model in primary care practice settings. We review common mechanisms used to procure payment for depression care management services, discuss obstacles encountered and suggest future directions.


METHODS
We describe several extant models for funding depression care management services in use at the demonstration sites of the Robert Wood Johnson Foundation funded "Depression in Primary Care" project and similar programs. We derived this information from ongoing discussions with the sites' project directors and through an extensive electronic literature search on "care management, funding mechanisms and depression."


RESULTS
Funding mechanisms include (a) practice-based care management on a fee-for-service basis, (b) practice-based care management under contract to health plans, (c) global capitation, (d) flexible infrastructure support for chronic care management, (e) health-plan-based care management, (f) third-party-based care management under contract to health plans and (g) hybrid models.


CONCLUSIONS
While substantial obstacles remain in the way of fully implementing these depression care management funding mechanisms (e.g., variations in care managers' credentials and work locations and third-party payer concerns about overutilization and transaction costs), several recent policy advances provide some optimism for the potential adoption of financial mechanisms to support and disseminate these evidence-based practices.
Bachman
John
J
Depression in Primary Care: Linking Clinical and Systems Strategies, National Program Office, Pittsburgh, PA 15213, USA. john94513@comcast.net
Pincus
Harold Alan
HA
Houtsinger
Jeanie Knox
JK
Unützer
Jürgen
J
D002204:Capitation Fee; D019090:Case Management / Q000191:economics*; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D018588:Fee-for-Service Plans; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007358:Insurance, Psychiatric / Q000145:classification*; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration*; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics*; D012944:Social Support; D014481:United States