Major health insurers and behavioral managed care companies operating in
New York City have signed onto a commitment to increase screening for
depression in primary care. And the companies have committed themselves in a"
charter" drafted in September to use a common instrument for such
Leaders of the effort say they will be encouraging the use of the nine-item
Patient Health Questionnaire (PHQ-9). That instrument is being used by the New
York City Department of Health and Mental Hygiene (DHMH) in its effort to make
screening for depression standard practice in primary care.
"It's a commitment on the part of the major commercial plans and
managed behavioral health firms," said Marilyn Wolff Diamond, M.P.H.,
director of quality initiatives for the New York Business Group on Health,
which is spearheading the effort. "We will be developing common
materials they can send out to the primary care physicians in New York City,
including information about the PHQ-9 and why they should use it."
Diamond told Psychiatric News that the effort was initiated by
employers in the city seeking to lower costs associated with depression at the
worksite, but said it was logical to "piggyback" on the existing
effort of the DHMH to disseminate the PHQ-9 (Psychiatric News,
Psychiatrist Lloyd Sederer, M.D., executive vice commissioner of the
department, said that for insurers it was important to agree on a common
screening instrument and common educational materials. In the past, insurers
have been developing their own separate protocols and materials, which have
often been ignored by primary care physicians inundated with too much
The charter agreement is a commitment to speak with "one voice"
about mental health, Sederer said.
The PHQ-9 was developed as part of the Primary Care Evaluation of Mental
Disorders (known as PRIME-MD) diagnostic system by Robert Spitzer,M.D., and
colleagues at Columbia University in col-laboration with researchers at the
Regenstrief Institute at Indiana University.
Darrel Regier, M.D., M.P.H., executive director of the American Psychiatric
Institute for Research and Education and director of APA's Division of
Research, has also championed use of the instrument.
"The PHQ-9 has emerged as one of the leading methods for assisting
both primary care physicians and psychiatrists to obtain a quantitative
assessment of depression severity and treatment response," Regier said
when commenting last year on the effort by the New York DHMH (Psychiatric
News, May 20, 2005).
"For the employer, an employee with depression may take excessive
sick days or be present at work, but not perform well," according to the
charter signed by New York Business Group on Health and insurers in the city."
Employers increasingly recognize the interplay between employee health
and well-being and business performance. The costs of undiagnosed employees
result in increased health care costs, absenteeism, and lost effectiveness
while at work."
The statement also says, "a coordinated and simple private-sector
approach will be developed to improve the quality of depression diagnosis,
delivery, and outcomes for employees and their families in the New York
Metropolitan area. Success will be determined by demonstrating measurable
improvements in percentage of people in the New York Metropolitan area
diagnosed with depression, quality of practitioner performance, and level of
employer engagement and support."
The charter's authors hope that their effort will become "an example
for collaborative initiatives across the country."
Initial tasks will focus on
Diamond said the fourth of these tasks will include dissemination of
information about appropriate referral of patients to psychiatrists.
Insurance companies signing on to the charter include Aetna, Cigna, Group
Health Incorporated, HIP Health Plan of New York, Health Net, Magellan Health
Services, Unitedhealth Group, and Value Options.
Information about the New York Mental Health Collaborative is posted