When it comes to mental health issues—particularly depression—research has shown that collaborative care is the most effective treatment available.
This model allows patients to access their Primary Care Physician (PCP), a consulting psychiatrist, and a case manager through one practice for coordinated mental health care. For patients, it offers faster, more comprehensive, and personalized care; for employers, it helps increase productivity and lower disability claims; and for health care plans, it helps reduce costs over time.
I’ve seen the power of collaborative treatment firsthand and, as President and CEO of the Northeast Business Group on Health (NEBGH), I believe it’s an integral part of the solution to our nation’s gap in mental health care.
Several years ago, as part of our work evaluating health plans for our members (a network of employers, providers, insurers, and other organizations throughout New York, New Jersey, Connecticut, and Massachusetts), NEBGH partnered with National Business Coalition on Health to perform an annual survey measuring the performance of health plans.
The data told us that the health plans were identifying a very small number of people as being diagnosed with major depressive disorder (much less than we would expect to find in the general population), but employers reported a very high number of claims for antidepressant medications. This revealed a major gap between diagnosis and treatment.
Given the wealth of literature and evidence that demonstrates the effectiveness of collaborative care models, we knew it could be the answer to dealing with this striking disparity. This kind of care unites the various aspects of the patient’s care, offering proper mental health diagnosis and treatment.
Since then, as we’ve worked to ensure that more people are properly diagnosed and treated, we’ve come across many obstacles within our current healthcare paradigm. Two significant issues include a nationwide shortage of mental health practitioners as well as hesitancy among many PCPs to diagnose and treat mental health conditions.
In addition to positively affecting access to care, the collaborative care model also affects the bottom line for businesses. Payment and reimbursement issues can become a significant concern depending on the setting where the model is introduced.
We’ve found that certain types of healthcare ecosystems and environments (e.g., closed systems like Kaiser or communities where not-for-profit health plans and/or large medical groups prevail) are more conducive to collaborative care, largely due to the fact that all members of the care team are employees of the health plan or medical group, which simplifies logistics and payment procedures.
For the greater part of America, health care is delivered in communities where many different providers, health plans, and groups practice separately, making the collaborative model difficult to implement. The lack of connectivity causes challenges, particularly when it comes to reimbursement. Because there are so many people and organizations involved, payment and billing issues become extremely complicated and the systems are rarely compatible.
Some of the other specific obstacles we’ve faced as we’ve worked to get larger-scale collaborative care off the ground include figuring out how to bill for phone calls or computer-based communication; finding the right case manager and psychiatrist; dealing with copays and deductibles triggered by the patient’s benefit plan; addressing PCPs’ concerns about reimbursement and workload; properly managing patient data; and gaining the support of national health plans.
We’ve partnered with physicians, health plans, employers, and consumers to implement our own small, multi-payer collaborative care pilot, the One Voice Initiative. The effort led to positive outcomes, but we have to expand it to build on our success.
All parties we’ve approached, from health plans to physicians, agree that collaborative care is the gold standard, but payers and providers are still unable to participate due to the payment issues discussed above.
NEBGH will continue to push for collaborative care for our members’ employees and all others in need of mental health treatment, but affecting change is going to require will and creativity. Together, we have to make the case for collaborative treatment and help the system evolve to meet the needs of people with mental health concerns.
Payment structures will also have to change—flexibility is key. Now that the Affordable Care Act is here to stay (at least for now), we’re hopeful that the current structure will change and grow.
All in all, this is about demand. Employers who are paying for the care need to demand collaborative care from plans and health care systems, patients who are receiving the care need to demand it from their plans and providers, providers who are giving the care need to demand it from the systems they work within—it requires advocacy by all stakeholders.
If we proceed with our current system—which offers inadequate care to patients in need—we’ll pour more dollars into an ineffective model and that’s unsustainable. We can do better.
It’s time we work together to make collaborative care our American standard and make sure that quality, effective treatment options are available to everyone who needs them.
- What do you see as the benefits of collaborative care?
- Why do you think collaborative care is not more widely available?
- What experience have you had with collaborative care?
Laurel Pickering is a leader and visionary, devoted to transforming healthcare at both regional and national levels. As President & CEO of Northeast Business Group on Health (NEBGH), Ms. Pickering has built an employer-led coalition of healthcare leaders and other stakeholders with the mission of empowering members to drive excellence and value in healthcare and the patient experience. Ms. Pickering is Chair of the Board of Directors of The Leapfrog Group, and serves on the Board of National Quality Forum (NQF) and National Business Coalition on Health (NBCH). Regionally, she is Chair of the Board of Directors of the NEBGH subsidiary HealthPass, a health insurance exchange for small businesses, and is also on the Board of Health Republic, a nonprofit health insurance plan in New York.