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Financing Early Psychosis Intervention Programs: Provider Organization Perspectives.

Yuhua Bao1, Michelle A Papp1, Rufina Lee1

  • 1Department 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.

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PubMed
Summary
This summary is machine-generated.

Financing coordinated specialty care (CSC) for first-episode psychosis is fragmented. Fee-for-service models and public funding threaten sustainability; bundled payments tied to outcomes are preferred.

Keywords:
Coordinated specialty care (CSC)FinancingFirst-episode psychosisFundingReimbursement

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Area of Science:

  • Health Services Research
  • Mental Health Policy
  • Psychiatric Care Delivery

Background:

  • Coordinated Specialty Care (CSC) is a critical intervention for first-episode psychosis.
  • Effective financing models are essential for the sustained implementation and scalability of CSC programs.

Purpose of the Study:

  • To identify current financing approaches for CSC.
  • To assess the alignment of these approaches with sustained CSC implementation.
  • To understand CSC provider perspectives on ideal payment models.

Main Methods:

  • Semistructured interviews with 19 CSC programs across 14 states.
  • Purposeful and snowball sampling of CSC administrators.
  • Integrated (inductive and deductive) thematic analysis of interview data.

Main Results:

  • CSC financing is characterized by a patchwork of funding sources: insurance billing (fee-for-service [FFS]), Mental Health Block Grant (MHBG) funds, and state funding.
  • FFS insurance billing presents limited coverage and restrictive rules misaligned with CSC.
  • Public funding (MHBG, state) faces sustainability challenges due to its grant nature.
  • Stakeholders advocate for bundled-payment models from payers, linked to client outcomes.

Conclusions:

  • Current reliance on FFS and public funding is unsustainable and misaligned with CSC objectives.
  • Payer-provider collaboration is crucial for developing tailored bundled-payment models.
  • Addressing diverse program needs requires flexible, outcome-oriented financing strategies.