Collaborative Care Leads to Better Behavioral Health Access

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The Collaborative Care conference was sponsored by BHECN, WellCare, Metro Omaha Medical Society (MOMS) UNMC, and Creighton University Medical Center. Pictured above: Martin Wetzel, M.D., with WellCare presented a $5,000 check to Carol Wang at MOMS & Dr. Liu at BHECN to support the training.

On October 13th and 14th, local behavioral health providers and primary care providers attended sessions on “Applying the Collaborative Care Approach: Evidence-based Mental Health Delivery in Primary Care Settings.”  This conference was held at CHI Health Bergan Mercy Hospital and the University of Nebraska Medical Center.  The attendance included behavioral health care managers, NP students, psychiatrists, psychiatry residents, family medicine residents, and beyond.  The goal of collaborative care is for better outcomes, lower cost, and better experience of care for patients.  Half of patients referred from the PCP office to a behavioral health specialist never follow through.  This model helps to intervene and make behavioral health care more accessible to patients.

The presenters of the conference included Anna Ratzliff, MD, PhD and John Kern, MD.  They practice at the University of Washington AIMS Center.  AIMS stands for Advancing Integrated Mental Health Solutions.  The University of Washington AIMS Center is a prototype of the model championed by the Transforming Clinical Practice Initiative (TCPI), which was funded by the Centers for Medicare and Medicaid Services (CMS).  We also have clinics here in Omaha practicing the AIMS model including One World Health Center.  Psychiatry residents at the joint UNMC-Creighton psychiatry residency rotate at One World and practice the AIMS model during their 4th year of residency.

The team at the center of the collaborative care approach consists of the PCP, a behavioral health (BH) care manager, and the psychiatric consultant.  The PCP interviews the patient, communicates with the care team, and prescribes the medication.  The BH care manager communicates with the care team, provides therapy to the patient, and follows up with the patient through individual sessions and phone calls.  A variety of BH career paths can become a care manager including MSW, LCISW, RN, PsyD, or PhD.  The psychiatric consultant reviews the patient cases, provides recommendations regarding medications and behavioral interventions, and communicates with the care team.  The randomized controlled trials evaluating the collaborative care approach for depression show better results than usual primary care remission rates. 

Psychiatric rating scales, such as the PHQ-9 and GAD-7, are used to assess and track progress in patient outcomes for improvement of depression and anxiety respectively.  A registry is created of the patients actively followed by the care team.  The registry provides a clear and concise way to track the patients and their most recent psychiatric scales.  This helps to keep patients from falling through the cracks and allows the team to focus on patients that are not improving.  The psychiatric consultant rarely sees patients face-to-face and does most of the information gathering through discussions with the care team and chart review. 

The conference included interactive Q&A’s, role playing, and case presentations.  The participants were given a sample registry and were instructed to assess patients based on their psychiatric rating scales and dates of their last visits.  The collaborative care approach is an evidence-based mental health delivery system that can be utilized in primary care settings to increase patient accessibility and outcomes.  This conference provided exposure for people in the behavioral health field and primary care providers regarding how the system works.       

Submitted by Stephanie Sutton, M.D.

 

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