While up to 80% of all primary care visits include a behavioral health component, primary care providers (PCPs) may feel overwhelmed and ill-equipped to meet their patients’ behavioral health needs. Collaborative care can help.

What is collaborative care?

Collaborative care is a specific type of integrated care that uses a team-based, patient-centered approach to address behavioral health in the primary care setting. Collaborative care links a patient’s PCP with a behavioral health care manager and psychiatric consultant to help meet their mental health goals. This approach has been studied in over 90 different randomized control trials and has shown to be highly effective in delivering a better patient experience, as well as improving patient outcomes and providing cost reduction.

Collaborative care gives PCPs the tools and support they need to manage ongoing mental healthcare and helps improve the quality of care provided.

• A patient registry allows PCPs to track patients and ensure that no one falls through the cracks. Patients who do not show improvement are outreached, and behavioral health specialists offer caseload-focused consultation.
• Screening tools, such as the Patient Health Questionnaire (PHQ)-9 for depression and the Generalized Anxiety Disorder (GAD)-7 for anxiety, help identify and direct patients to the appropriate levels of care for mental health conditions.
• A behavioral health care manager supports the PCP in myriad ways, including:
  • Ensuring effective communication among the team
  • Coordinating the team and mental health treatment
  • Providing progress updates and treatment recommendations to the provider
  • Alerting the PCP when the patient is not improving
  • Supporting medication management
  • Facilitating communication with the psychiatric consultant regarding treatment changes
  • Conducting brief interventions, such as motivational interviews with patients to guide their progress
• A psychiatric consultant reviews cases alongside behavioral health care managers and assists the care team with treatment planning, and diagnostic and treatment recommendations.

Collaborative care allows patients to get mental healthcare where they regularly seek physical healthcare, rather than having to go elsewhere.

 Throughout the U.S., individuals lack access to mental healthcare. In fact, over 26 million individuals experiencing a mental health condition are going untreated. Providing mental healthcare in the primary care setting allows patients to:

• Address mental health concerns with a provider they trust and see regularly for physical health concerns
• Receive mental health treatment at an earlier stage to help prevent more serious problems
• Have regular contact with a behavioral health care manager who can deliver brief interventions and individualized care planning
• Receive coordinated care for co-occurring mental and physical conditions
• Reduce the burden they carry in communicating treatment updates to multiple providers when they have comorbid physical and mental health concerns
• Feel comfortable that all of their health needs are being addressed
• Receive mental health treatment that is often less expensive

Magellan Healthcare’s collaborative care solution, powered by NeuroFlow

 Collaborative care has been proven to double the effectiveness of depression care, as well as improve physical function and reduce healthcare costs. Magellan Healthcare’s evidence-based Collaborative Care Management solution for health plans and healthcare delivery systems provides care management and psychiatric consults for primary care patients and augments physical health providers’ staff with Magellan staff to facilitate integrated physical and behavioral healthcare. Learn more here.

Sources:

• 2020 Adult Data | Mental Health America (mhanational.org)
• Benefits of Behavioral Health Integration for Primary Care Providers | Bipartisan Policy Center
• Collaborative Care | University of Washington AIMS Center (uw.edu)

Behavioral health is an important indicator of a society’s overall wellbeing, as it interacts closely with physical health. Unfortunately, most individuals do not receive the behavioral health treatment they need. Fear of treatment, shame, and embarrassment keep many from seeking care. More than one-third of Americans live in areas lacking mental health professionals.[1] Fifty percent of individuals who receive a behavioral health referral do not follow through or have only one visit.[2] Collaborative care addresses these problems by providing physical and behavioral health care in the primary care setting.

What is collaborative care?

Collaborative care is a specific type of integrated care developed at the University of Washington’s AIM Center that treats common mental health conditions, such as depression and anxiety, that require systematic follow-up due to their persistence. Based on principles of effective treatment of chronic illness, collaborative care focuses on defined patient populations tracked in a registry, measurement-based practices, and treatment to target. Trained primary care providers and embedded behavioral health professionals provide evidence-based medication or psychosocial treatments, supported by regular psychiatric case consultation and treatment adjustment for patients who do not improve as expected.[3]

Principles of collaborative care

Developed in consultation with a group of national experts in integrated behavioral health care in 2011 with the support of the John A. Hartford Foundation, The Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, and California Healthcare Foundation, five core principles define collaborative care and should inform every aspect of implementation to ensure effective collaborative care is practiced.[4]

• Patient-centered team care—Primary care and behavioral health providers effectively work together using shared care plans that include patient goals. Being able to receive both physical and mental health care in a familiar location provides patients with comfort and reduces duplication of assessments. Increased patient engagement often leads to a better health care experience and improved patient outcomes.
• Population-based care—Care teams share a specific group of patients that are included in a registry. The registry is used to track patients and ensure that no one falls through the cracks. Patients who do not show improvement are outreached, and behavioral health specialists offer caseload-focused consultation.
• Measurement-based treatment to target—Each patient’s treatment plan includes personal goals and clinical outcomes that are measured using evidence-based tools, such as the Generalized Anxiety Disorder scale on a routine basis. If patients do not improve as expected, treatments are adjusted until clinical goals are met.
• Evidence-based care—Patients receive treatments with sound research evidence to support their efficacy in the treatment of the target condition, including various evidence-based psychotherapies that have proven effective in primary care, such as problem-solving treatment, behavioral activation, and cognitive behavioral therapy, and medicines.
• Accountable care—Providers are responsible for and receive reimbursement for the quality of care and clinical outcomes, not just the volume of care provided.

Collaborative care has been proven to double the effectiveness of depression care, improve physical function, and reduce health care costs. Magellan Healthcare’s evidence-based Collaborative Care Management product, enabled by NeuroFlow, provides care management and psychiatric consults for primary care patients and augments physical health providers’ staff with Magellan staff to facilitate integrated physical and behavioral healthcare. Learn more here.

[1] https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/

[2] https://aims.uw.edu/collaborative-care

[3] https://aims.uw.edu/collaborative-care

[4] https://aims.uw.edu/collaborative-care