Innovation summary

In the US there currently exists a treatment gap for common mental disorders. This gap may be due to limited access to care resulting from a combination of lack of mental health specialists, stigma associated with getting care and/or financial limitations.

Collaborative Care’s goal is to treat the large numbers of people suffering unnecessarily from mental illness by providing a model of care that integrates mental and physical health care in familiar settings.

Collaborative Care provides evidence-based treatments for common mental disorders using a population-based approach.  Skilled mental health specialists support health professionals in familiar settings such as primary care clinics and school-based health centers, effectively bringing mental health treatment to where people feel comfortable receiving care.

Impact summary

  • Collaborative Care has worked with over 600 organizations, trained more than 6,000 clinicians, and been implemented in large scale projects such as the Washington State’s Mental Health Integration Program (serving 35,000 patients)
  • In over 80 randomized controlled trials it has been shown to be more effective than treatment as usual using validated clinical outcome measures (e.g. PHQ-9 for depression)
  • Collaborative Care has proven more cost effective than treatment as usual, with $6.50 USD  saved in healthcare costs for every $1 USD spent

“You have no idea how helpful it is for a primary care provider to have a resource like Collaborative Care in the clinic. I practiced for 16 years without it and I will never go back!”

 

-Primary Care Physician, UW Neighborhood Clinic

Innovation details

Collaborative Care is delivered by a team consisting of a primary care provider, care manager (nurse, clinical social worker, or psychologist), and psychiatric consultant.

The team cares for a defined group of patients and closely tracks each patient’s progress using validated clinical rating scales (e.g. PHQ-9 for depression). Treatment is systematically adjusted if patients are not improving as expected. Patients who don’t respond to treatment are referred to more intensive mental health specialist care.

Psychiatric consultations are largely conducted via phone with the care manager (and sometimes the primary care provider) with direct patient consultations focused on those patients who are presenting diagnostic or therapeutic challenges to the team. These consultations can be performed face-to-face or using televideo equipment. This systematic stepped care approach can help overcome the clinical inertia that is often responsible for patients continuing on ineffective treatment.

Key drivers

An innovation way of thinking

  • Implementing Collaborative Care requires a new way of thinking about how mental health care is delivered and usually requires significant and often times challenging change in clinical practice

Adaptability

  • Each clinic must create a workflow that meets the needs of their patients, identify how it will track patient treatment and outcomes, and clearly define the roles of its team members – the care manager, primary care provider, and psychiatric consultant
  • The clinics that are best able to be adaptable and flexible are the ones rewarded with the greatest amount of success

Challenges

Finances

  • Securing the necessary financing to support its different components, especially in the context of health insurance reimbursements, is a challenge
  • Movement toward bundled payments rather than fee-for-service models can help

Orchestrating change

  • A second challenge is orchestrating the clinical practice change necessary for successful implementation to occur

Continuation

Collaborative Care has been adapted and implemented throughout the US and around the world. Below are just a few of the large-scale Collaborative Care implementations to date:

  • Washington State’s Mental Health Integration Program (MHIP), a state-wide behavioral health model serving 35,000 patients since its inception in 2008
  • DIAMOND – Study of Minnesota State-wide Integrated Depression Care Initiative, a collaborative effort of nine health plans, 25 medical groups, and over 80 primary care clinics in Minnesota to implement and study the IMPACT model of depression care
  • COMPASS – Mind and Body Health, a CMMI Triple Aim Challenge Grant testing if an integrated care approach in primary care clinics for patients with depression and diabetes, heart disease and/or risky substance use meets the triple aim of improved patients experience, better outcomes and lower costs

Partners

The University of Washington’s AIMS Center (Advancing Integrated Mental Health Solutions)

Funders:

Organizations that implement Collaborative Care are responsible for funding any training or technical support required.

Evaluation methods

  • Both research and real world experience have demonstrated the success of Collaborative Care and how it helps achieve the triple aim of improved patient care experiences, better clinical outcomes, and lower health care costs
  • Collaborative Care has been shown to be more effective than usual care in more than 80 randomized controlled trials and has become increasingly relevant in the context of Patient Centered Medical Homes and Accountable Care Organizations
  • Evaluation of patient progress is done with evidence-based clinical rating scales that support Collaborative Care.

Cost of implementation

Lower per capita cost

  • Collaborative Care makes efficient use of limited resources. Limited mental health specialty capacity (e.g., psychiatry or psychology) is effectively leveraged through supporting treatment for common behavioral health conditions in primary care. Face-to-face psychiatric consultation focuses on patients who are not improving as expected
  • Systematic treatment-to-target reduces clinical inertia and helps reduce costs associated with well-intended treatments that are not achieving results (e.g., unnecessary duplication of services, emergency department or hospital visits, medications and other treatments that are not effective)
  • Collaborative Care is more cost-effective than usual care. Research shows that up to $6.50 USD is saved in health care costs for each dollar spent on Collaborative Care, a return on investment of over 6:1
  • Systematic tracking of clinical outcomes at individual and population levels facilitates accountable care and helps maximize the value of services provided. Recent research suggests that ‘Payment for Performance’ can further enhance the cost-effectiveness of Collaborative Care programs

Impact details

Better experience of care

  • Collaborative Care can provide access to evidence-based behavioral health services for millions of individuals who currently do not receive effective mental health specialty care
  • An effective Collaborative Care  team can address medical and behavioral health problems and the powerful interactions between these conditions in one place
  • Patients prefer such patient-centered, well-coordinated and effective care
  • Providers enjoy working as part of an effective team and having a bigger impact on the health of individual patients and populations

Improved Health of a Population

  • Collaborative Care focuses on a population of patients rather than only those who present for care
  • Patients are actively tracked in a registry to prevent them from ‘falling through the cracks’
  • Treatment outcomes are measured using validated clinical outcome measures and treatment is systematically adjusted and/or intensified until treatment targets are achieved

Research

Tools

Multimedia

Reports
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Country

United States of America

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