Collaborative Care Model Improves Access and Outcomes for Members with Mental Health Needs
Behavioral Health Insights
By Micah Hoffman, MD, DABPN, FAPA, QME, CIME, CHCQM
AllMed Behavioral Health Medical Director
Mental and behavioral health conditions such as depression, anxiety, and substance abuse affect millions of Americans every year, taking a heavy emotional, physical, and economic toll. These conditions are deeply tied to physical well-being—for example, people with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population, and people with serious mental illness are nearly twice as likely to develop these conditions.1 Despite the clear connection, the United States health care system has long separated physical health treatment from mental health care. This fragmentation has made navigating the system notoriously difficult for people with mental health issues, who struggle with stigma, a shortage of mental health specialists, and a lack of follow-through. As a measure of the extent of the problem, the U.S. Surgeon General reports that, only 1 in 10 people who need treatment for substance use ever receive it, and fewer receive high-quality, evidence-based care.2
Health plans, providers, and policymakers are focused on bridging the gap between mental and physical health care to ensure that individuals receive the holistic support they need. Influenced by strong evidentiary findings, many are implementing programs based on the collaborative care model (CoCM), a specific type of integrated care. This solution, which integrates mental health into a primary care practice, has proven to be a powerful tool, yielding impressive results in treating patients with depression, anxiety, and other mental health issues. In one real-world example, Penn Medicine’s collaborative care program, with patients enrolled throughout Pennsylvania and New Jersey, has achieved a 50 percent depression and anxiety remission rate—that is, not having clinically meaningful symptoms of depression or anxiety as measured by evidence-based self-reported assessments.3 CoCM shows promise for similarly positive outcomes for patients with substance use disorders.
AllMed supports providers treating members with depression, anxiety, and substance use disorders, whether in a CoCM or traditional model, with expert opinions and guidance from our panel of board-certified mental and behavioral health specialists.
How and Why CoCM Works
Collaborative care is not a new concept but adapting the model to integrate mental and behavioral health into primary care is a relatively recent advance, made achievable by Medicare and Medicaid policy changes. The way CoCM typically works is that when patients visit their primary care provider for an acute problem or check-up, they are given a universal depression screening as part of the intake process.
If the screening indicates a concern, or if the primary care physician identifies a concern, a more thorough assessment is given. The physician and patient then determine whether a referral to specialty mental health care is needed or whether care can be provided in the primary care setting with the help of a clinical social worker/care manager working in tandem with the primary care physician and a consulting psychiatrist. Patients with more complex needs are referred to specialty mental health providers while those with more straightforward conditions are treated in their familiar primary care setting. This efficient, relatively seamless referral process removes obstacles to care, relieving patients of the need to search for a psychiatrist or specialty provider. All patients are then tracked in a registry, ensuring that they receive the consistent follow-up essential to successful treatment.
For physicians, knowing that they have support and a solution standing by makes it easier to broach the topic of mental health with their patients. These conversations, conducted during routine office visits, help normalize the experience of discussing (for providers) and seeking (for patients) mental or behavioral health services. CoCM gives providers the tools to treat patients rather than spending hours frustrated in not being able to complete referrals.
The mental health assessment, first administered during the intake process, is critical throughout treatment, serving as an objective measurement tool, so that patient progress can be monitored. As in treatment of a medical condition such as diabetes, standardized measurement is key to understanding and successfully treating mental and behavioral health issues.
A Strong Evidence Base
Beginning with the IMPACT study, the first large randomized, controlled trial of treatment for depression, published in 2002, CoCM has been tested in more than 90 randomized, controlled trials in the U.S. and abroad. These trials and several recent meta-analyses make it clear that CoCM consistently improves on care as usual for patients with depression, anxiety, and other behavioral health conditions, leading to better patient outcomes, better patient and provider satisfaction, improved functioning, and reductions in healthcare costs.4 In addition, CoCM shows great potential for ameliorating racial and ethnic disparities in mental and behavioral health care.5
Specific to substance use disorders, results of the SUMMIT Randomized Clinical Trial of over 15,000 clinical visits found that, relative to the usual care, collaborative care intervention in primary care increased both the proportion of patients receiving evidence-based treatment and the number achieving abstinence at 6 months.6 While members with more specialized or complex mental health needs may still need to be referred to a specialty provider, CoCM enables a large percentage of those with substance use disorders to receive effective treatment in a primary care setting.
Overcoming Implementation Hurdles
Implementing CoCM requires a practice change on multiple levels, which can seem overwhelming for already overburdened practices. The prospect of up-front costs related to hiring and training additional team members and pains associated with updating existing workflows can feel daunting. But the results of multiple studies highlighting improved outcomes and significant savings underscore the value of making the shift. A 2020 study found that collaborative care implementation for mental health teams was associated with significant reductions in mental health hospitalizations, leading to substantial cost savings of about $1.70 for every dollar spent for implementation.7
In the past, reimbursement challenges also hampered implementation efforts, creating another barrier to treatment. Now, however, the collaborative care model is supported with sufficient payment through new CPT codes. These codes allow for reimbursement for a set of team-based services provided under indirect supervision of the primary care provider through medical insurance, thus providing a financially stable way of supporting CoCM-based programs.8
Making CoCM Work for Your Members
As the evidence supporting the effectiveness of CoCM grows, health plans and states with widely varied demographics are finding innovative ways to implement the model for the benefit of their member populations. AllMed is proud to support these efforts through our review services. Our behavioral health panel is ready, on demand, with clinically sound recommendations for primary care providers, whether working in a collaborative care setting or not. Our board-certified specialists provide evidence-based guidance on treatment modalities and medications, helping you ensure the most effective treatment for your members.
- Firth, J., Siddiqi, N., et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Jul 16, 2019. DOI:https://doi.org/10.1016/S2215-0366(19)30132-4.
- Surgeon General’s Report on Alcohol, Drugs, and Health. Key Findings: Early Intervention, Treatment, and Management of Substance Use Disorders. https://addiction.surgeongeneral.gov/key-findings/early-intervention. Accessed August 25, 2022.
- American Medical Association. Collaborative care model for mental health, addiction treatment. Dec. 30, 2020. https://www.ama-assn.org/delivering-care/public-health/collaborative-care-model-mental-health-addiction-treatment. Accessed August 26, 2022.
- University of Washington AIMS Center. Collaborative Care. http://aims.uw.edu/collaborative-care. Accessed August 24, 2022.
- Hu J, Wu T, Damodaran S, Tabb KM, Bauer A, Huang H. The effectiveness of collaborative care on depression outcomes for racial/ethnic minority populations in primary care: a systematic review. Psychosomatics. 2020 Nov-Dec. https://pubmed.ncbi.nlm.nih.gov/32381258/. Accessed August 24, 2022.
- Watkins K, Ober A, et al. Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care. JAMA Internal Medicine. Oct. 2017. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2652574. Accessed August 26, 2022.
- Miller CJ, Griffith KN, et al. An Economic Analysis of the Implementation of Team-based Collaborative Care in Outpatient General Mental Health Clinics. Medical Care. Oct. 2020. https://journals.lww.com/lww-medicalcare/Abstract/2020/10000/An_Economic_Analysis_of_the_Implementation_of.5.aspx. Accessed September 11, 2022.
- American Medical Association. 2020.