Collaborative Care

What is the Collaborative Care Model?

Collaborative Care (CoCM) is a patient-centered integrated behavioral care model that proactively addresses mental health concerns in the primary care setting. CoCM was developed at The University of Washington’s Advancing Integrated Mental Health (AIMS) Center and first studied in the groundbreaking IMPACT trial in 20021. This randomized controlled trial, with over 1,800 patients, showed that compared to usual care, CoCM doubled the effectiveness of treating depression. In addition to the IMPACT trial, over 80 additional randomized control trials have demonstrated the model’s success in improving behavioral health outcomes for individuals with depression from 6 months through 5 years2,3. Additional studies have shown the model’s success in improving other behavioral health conditions, such as anxiety2, PTSD4, and comorbid conditions such as diabetes5 and cancer2. Furthermore, the model has been proven to reduce long-term health care costs3.

Click here for more information on the IMPACT Trial.

 

 

Who Provides Treatment in the Collaborative Care Model?

This team-based model of care includes the primary care provider (PCP), behavioral health care manager (BHCM), psychiatric consultant, and the patient. This collaborative approach allows each member of the team to contribute their expertise to help guide the patient’s treatment.

Click here to learn more about the CoCM treatment team.

 

Target Population

CoCM has been proven to be effective in treating a variety of populations, specifically individuals with mild to moderate behavioral health conditions. There is a growing body of evidence to supporting CoCM treatment for individuals with co-morbid chronic medical conditions, PTSD, and bipolar disorder, as well as treatment for adolescent and obstetric patients.

 

While effective for most individuals in this population, this model may not be the best treatment option for every patient. With proactive follow-up, the BHCM will monitor patients who are not improving with the model and work to direct them to the appropriate type of care.

 

 

Principles of the Model

The following five principles are fundamental to the successful delivery of the Collaborative Care model. Click each component to learn more.

Patient-Centered Care

A shared treatment plan is developed through close collaboration between PCPs, behavioral health providers, and patients.

Population-Based Care

Patients are tracked in a patient registry to ensure no one falls through the cracks

Measurement-Based Treatment to Target

Patients have measurable treatment goals that are defined and tracked, and treatment is proactively adjusted based on the patient’s response.

Evidence-Based Care

Patients are engaged in evidence-based brief therapies, such as motivational interviewing, problem-solving therapy, and behavioral activation. These interventions are proven to work well in primary care.

Accountable Care

Providers are reimbursed for quality of care, clinical outcomes, and patient satisfaction.

Clinical Activities

CoCM uses specific clinical activities to enhance patient care. These activities allow the treatment team to effectively practice proactive, team-based care. Click each activity to learn more.

Structured Assessment of Mental Health Conditions

After the PCP refers a patient to the BHCM, the BHCM conducts a structured assessment of patients’ needs and behavioral health conditions. This facilitates appropriate diagnosis of the primary condition and accompanying conditions.

 

Initial Triage to an Appropriate Level of Care

Based on the assessment, the BHCM triages the patient to the appropriate level of care. Appropriate patients with mild to moderate mental health conditions are offered and subsequently enrolled in the CHC’s CoCM program.

 

Patients requiring a higher level of care are connected with specialty mental health resources, as needed. Patients with emergency needs are engaged in risk assessment and safety planning as clinically indicated, and may have a facilitated emergency department consultation.

 

Psychiatric Consultation, Treatment Planning, and Team Communication

Each week, the BHCM prepares clinical summaries and reviews the registry of patients in collaborative care with the psychiatric consultant. During these panel reviews, the BHCM and psychiatrist discuss new referrals and identify patients whose symptoms have not improved. The BHCM also comes prepared with specific case questions that have arisen throughout the week. The psychiatrist makes recommendations that are relayed to the patients’ PCP through the BHCM and the electronic health record. PCPs discuss with the BHCM and decide with their patients whether to make the recommended changes.

 

The psychiatric consultant is available to the PCP to discuss recommendations and patients, though PCPs often find that the use of the BHCM as a liaison is preferred over taking the time to directly interact with the psychiatric consultant.

 

Ongoing Monitoring and Support

The BHCM maintains regular contact with patients, remaining available for co-visits with PCPs, as well as speaking with patients by phone and/or face-to-face in between PCP visits. The BHCM uses standardized outcome measures to track symptom progress, monitors response to treatment, connects patients with necessary resources, and engages the patient in routine discussions surrounding their self-management plan.

 

Brief Therapeutic Interventions

Based on their goals and treatment needs, the BHCM can engage patients in brief therapeutic interventions. These include problem-solving therapy, motivational interviewing, and behavioral activation. These therapies are evidence-based and feasible in the primary care setting.

 

Ongoing Consultation and Tailored Treatment Planning

The initial treatment plan is regularly updated to reflect the patient’s response to treatment. As patients improve, symptom monitoring becomes less frequent. Conversely, if symptoms do not improve, the treatment plan is proactively modified per recommendations from the psychiatric consultant. If patients do not respond to treatment as expected, they may be evaluated by the psychiatric consultant via an in-person or telepsychiatry visit.

 

At times, patients may need to be referred on to specialty care, which the BHCM can help facilitate. One of the goals of CoCM is for patients to move seamlessly throughout the continuum of services as the team supports them on their trajectory to remission.

 

Relapse Prevention Plan

When patients enter remission, the BHCM works with them to develop a relapse prevention plan, providing guidance on how often to review the plan and what to do if symptoms worsen.

 

What are the Financial Benefits of Collaborative Care?

Collaborative Care proactively addresses behavioral health conditions, which reduces long-term costs in lost productivity and health care expenditures. This is financially beneficial for patients, health centers, and health plans.

Click here to learn more.

 

 

References

1. Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., … Langston, C. (2002). Collaborative Care Management of Late-Life Depression in the Primary Care Setting. The Journal of the American Medical Association, 288(22), 2836–2845.

2. Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., … Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews, (10), 1–276. https://doi.org/10.1002/14651858.CD006525.pub2

3. Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes. Archives of Internal Medicine, 166, 2314–2321. https://doi.org/10.1001/archinte.166.21.2314

4. Engel, C. C., Bray, R. M., Jaycox, L. H., Freed, M. C., Zatzick, D., Lane, M. E., … Katon, W. J. (2014). Implementing Collaborative Primary Care for Depression and Posttraumatic Stress Disorder: Design and Sample for a Randomized Trial in the U.S. Military Health System. Contemporary Clinical Trials, 39, 310–319. https://doi.org/10.1016/j.cct.2014.10.002

5. Katon, W. J., Von Korff, M., Lin, E. H. B., Simon, G., Ludman, E., Russo, J., … Bush, T. (2004). The Pathways Study: A Randomized Trial of Collaborative Care in Patients With Diabetes and Depression. Archives General Psychiatry, 61, 1042–1049.