Joint Report Provides ‘How-to’ Guidance for Implementing Collaborative Care

A detailed description of “collaborative care” as it is practiced by five diverse health systems is available in a new report issued jointly by APA and the Academy of Psychosomatic Medicine (APM).

The report, “Dissemination of Integrated Care Within Adult Primary Care Settings: The Collaborative Care Model,” highlights successful examples of the implementation of collaborative care at the Washington State Mental Health Integration Program (MHIP); Depression Initiative Across Minnesota—Offering a New Direction (DIAMOND); Re-Engineering Systems of Primary Care Treatment of PTSD and Depression in the Military (RESPECT-MIL); Veterans Health Administration; and the UC Davis Health System.

“The evidence is clear that integrated care, and the collaborative care model in particular, can contribute to more effective care and better outcomes for patients with mental illness who are going to their primary care physicians for treatment,” said APA President Renȳe Binder, M.D. “This report will help standardize educational materials and effective implementation of the collaborative care model.”

The 85-page report is the most comprehensive compilation to date of information about collaborative care, the model of integrated care that has the largest body of evidence-based research on effectiveness. It provides a “real-world,” how-to guide for implementing collaborative care.

The highlighted health systems are diverse and have different payment mixes, Eric Vanderlip, M.D., M.P.H., co-chair of the work group that developed the report, told Psychiatric News. “Each of those examples is described in a standard format so that readers can compare apples to apples, and someone who wants to do it can see how these different systems have done it.

“These five systems—the VA, the University of Washington, the military, the DIAMOND program in Minnesota, and UC Davis—are the progenitor programs,” he said. “The point is to provide guidance and information to psychiatrists and the larger primary care workforce, as well as to payers and policymakers about what exactly collaborative care is and what it looks like in five diverse health systems.”

The report includes separate chapters detailing the following:

• A summary of evidence-based research supporting the effectiveness of collaborative care.

• Essential elements of the collaborative care model.

• Analysis of how the model, when successfully implemented, provides for accountability and quality improvement.

• Unique attributes of psychiatrists within the collaborative care model.

• “In vivo” implementations of the collaborative care model.

• Future directions and recommendations.

Of particular interest to APA members is the chapter on the unique attributes that psychiatrists bring to collaborative care. They include training in both medicine and behavioral health; education of others on the collaborative care team about behavioral health issues; collaboration, consultation, and partnership with primary care providers; team leadership, vision, and accountability; and alleviation of problems related to medico-legal liability.

With the regard to the latter, the report notes that current literature and case law suggest the relative risk of curbside consultation is minimal, and that the medico-legal risk to a psychiatrist for providing organized advice on a patient not physically seen is less than for providing direct care. That’s because the patient is under the principal care of another provider. “Access to a specialist with expertise in both diagnosis and management helps to alleviate medico-legal concerns that inevitably arise when managing behavioral health disorders in the community,” the report states.

Vanderlip said the document is intended to clarify for practitioners, policymakers, and payers the essential features of what has become the most prominent model of integrated care.

“Even among psychiatrists interested in integrated care, there is some confusion about what we are talking about when we talk about collaborative care,” Vanderlip said. “We think the report provides very nuanced examples from real-world experience with collaborative care so that readers will have easily digestible information about what is meant by, for instance, population-based care or team-based care. These terms have been out and about for a while, but the joint report for the first time spells it all out.”

Serving as co-chair of the work group was James Rundell, M.D., a member of the council of the Academy of Psychosomatic Medicine and a professor of psychiatry at the University of Minnesota School of Medicine. Other work group members included Marc Avery, M.D., of the University of Washington; Carol Alter, M.D., senior director of medical policy and quality at AstraZeneca, U.S. Medical Affairs; Charles Engel, M.D., M.P.H., senior health scientist at RAND Corporation; John Fortney, Ph.D., of the University of Washington; David Liu, M.D., of the UC Davis Health System; and Mark Williams, M.D., of the Mayo Clinic. ■