Service

Delivery
Model at
Teen Health
Corners
Rachel Soles, MSN, RN,
NP-C

Contract mental health providers through Pine Rest

Christian Mental Health Services (PRCMH).

Teen Health Corners (THC) pay contract rate plus

expenses for required 32 hours of mental health
services.

Neither THC nor PRCMH bill for mental health services.

Contract model provides minimal opportunity for case

conferencing.

Lack of continuity of mental health clinicians.

Current Mental Health Service Model

THCs grant funding requirements changed in FY 20142015 increasing required weekly mental health service
hours to 32 (previously 16-20 hours were provided
during the school year and 8-12 during the summer)

THC will be required to bill for mental health services

beginning in FY 2016-2017 (recommended beginning
in FY 2014-2015).

Mental health providers are under-utilized in the

summer months.

Impetus for Change in Mental Health

Model

Required changes in mental health service hours and

billing requirement represent opportunity to revise
entire mental health service model.

Integrated mental and physical health models have

demonstrated improvements in quality of care
delivered (Collins et al., 2010; Benzer et al.,2015 ) .

THC and similar clinics funded through the Child and

Adolescent Health Center (CAHC) program through the
Michigan Department of Health and Human Services
provide a unique venue for truly integrated care.

Mental Health Innovation Potential

Move to an
employed
mental health
provider model

Select an
integrated
mental
health/physical
health model
(e.g. Cherokee
Health
Systems
Model).

Proposed Innovation

Implement
mental health
billing.

Decrease financial strain on THC created my mental

health service hour requirement increase.

Improve clinic efficiency.

Improve mental health quality of care.

Increase mental health patient census.

Innovation Objectives

Option 1: Continue to contract with PRCMH for

services, implement billing

Option 2: Employ one 0.8 FTE mental health provider,

implement billing.

Option 3: Employ two 0.4 FTE mental health providers,

implement billing.

Innovation
Alternatives:
Relative
Advantages/Disadvant
ages

Anticipated Expenses:

Total annual contract payment: $54,400 ($34/hr x 32

hrs x 50 weeks)

Total annual mileage expenses: $2,880 ($240/month

fixed rate)

Total: $57,280

Revenues:

Expected annual insurance reimbursement: $15,892

(436 billable visits annually x 36.45 Medicaid
reimbursement rate)

Net:1
($41,388)
Option
Financials

Expenses:

Total annual salary: $41,600 ($25/hr x 1664 hours)

Total annual fringe expenses: $14,560 (35% of salary)

Annual Continuing Education allowance: $1,500

Supervision: $2400

Total: $60,060

Revenues:

Expected annual insurance reimbursement (year 1): $15,892 (436 billable

visits annually x 36.45 Medicaid reimbursement rate)

Net: ($44,168)

Expected annual insurance reimbursement (year 2): $19,293 (528 billable

visits)
Net: ($40,767)

Option 2 Financials

Expenses:

Total annual salary: $41,600 ($25/hr x 1664 hours)

Total annual fringe expenses: $9,152 (22% of salary)

Annual Continuing Education allowance: $1,500 ($750 x 2 providers)

Supervision: $0-2400*

Total: $54,652

Revenues:

Expected annual insurance reimbursement (year 1): $15,892 (436 billable

visits annually x 36.45 Medicaid reimbursement rate)

Net: ($38,760)

Expected annual insurance reimbursement (year 2): $19,293 (528 billable

visits)
Net: ($35,359)

Option 3 Financials

Diagnostic evaluation (no medical)

$87.75

Diagnostic evaluation (with medical)

$72.30

Psychotherapy 30 minutes

Psychotherapy for crisis 60 minutes

Smoking and tobacco use cessation >10 minutes

$13.68

Health Behavior Assessment 15 minutes

$36.45
$74.28

Mental Health Billing- Medicaid

Reimbursement Rates

$?

Part-time vs Full-time mental

health providers

Qualifications of providers

Supervision

Barriers/Considerations

Outcome measures:

Patient satisfaction
Risk assessment completion
rates
Staff satisfaction
School teacher/counselor
satisfaction
Mental health census
Mental health productivity (with
revision of goals as appropriate)

Innovation Evaluation

References
Benzer, J.K., Cramer, I.E., Burgess, J.F., Mohr, D.C.,
Sullivan, J.L., & Charns, M.P. (2015). How personal and
standardized coordination impact implementation of
integrated care. BMC Health Services Research, 15,
448-457, doi: 10.1186/s12913-015-1079-6
Collins, C., Hewson, D.L., Munger, R. & Wade, T. (2010).
Evolving models of behavioral health integration in
primary care. Milbank Memorial Fund. Retrieved from:
http://www.milbank.org/uploads/documents/10430Evolvi
ngCare/EvolvingCare.pdf