Improving Patient Outcomes: Collaborative Care in Primary Care Settings

Patients need better access to behavioral health care. On a recent episode of the Mind Matters podcast, Dr. Mena Mirhom, chief medical officer of Concert Health spoke with Dr. Kyle John, clinical vice president of behavioral health at Mercy Health about the increased demand for timely behavioral health access. “The old system of behavioral health care is broken.” Dr. John goes on to state, “We cannot hire our way out of the problems that we have in regards to access.”

Finding feasible ways for patients to receive quality, affordable and timely access to behavioral care is the lingering problem we are all working to solve. Virna Little, chief clinical officer and co-founder of Concert Health expands on some of the factors attributing to the problem with access. “Accessing behavioral health treatment in the U.S. is a challenge, full stop. Confusing insurance plans, uneven coverage and overwhelming provider networks leave [patients] at a loss on where to start.”   

Let’s increase the sense of urgency and importance for behavioral health treatment access by factoring in comorbidities. Patients with behavioral health issues greatly increase the risk of suffering from many physical health problems. Specifically, poor behavioral health has been linked to poor outcomes in diabetes care as well as cardiovascular disease.

Mental health affects physical health and vice versa. The body and the mind are inextricably linked. Treating the mind and body separately has led to significant health inequalities, barriers to health care and substantial medical spend for some of the most vulnerable patients.

Collaborative Care: Behavioral health access in primary care settings

It's no surprise that most individuals forgo even attempting to get mental health care. The small percentage who seek help often turn to their primary care provider (PCP). The overworked PCP has little time and resources to provide the patient the help needed to get better.

What if there was a way for patients to receive proper behavioral health treatment in that same PCP’s office — but with behavioral health experts in tow?

Collaborative Care is a team-based model of integrated psychiatric and primary care that can identify and treat mental illnesses. The care team includes the patient’s PCP, a mental health clinician and a board-certified psychiatrist. Working together, this care team provides a care plan for the patient that includes expert analysis and takes into consideration the patient’s medical history.

How does it work?

If a patient meets the criteria for a Collaborative Care referral, the PCP can talk with the patient about enrolling in treatment. Collaborative Care is not limited to adults — children and adolescents can also fit the criteria.

Treatment is truly patient centered. Modalities include evidence-based behavioral health treatment proven to work in primary care, such as PST, BA, CBT, and medications. In practice, clinicians can help patients identify and achieve their behavioral health goals. Specifically, the clinician will help the patient learn skills to manage symptoms and set goals to support routines and ultimately positive lifestyle changes. Clinicians can also help connect patients to helpful resources (i.e., financial support, support groups, housing assistance). A Psychiatric Consultant meets with the Clinician to thoroughly review the patient's chart and provide expert treatment and medication recommendations to the PCP.

In terms of treatment logistics, behavioral health clinicians will work with a patient over video or telephone. Once a treatment plan is established, most “contacts” between the clinician and the patient last between 10-15 minutes and cadence of sessions start with one or two per week.

To ensure the patient improves during treatment, Collaborative Care uses patient-reported outcome measures to drive clinical decision-making, such as symptom rating scales. If a patient is not improving, the care team will work together to alter certain aspects of the treatments. Through a shared EMR, the care team has access to all treatment updates.

Improving patient outcomes, lowering medical spend

Concert Health is an example of how to leverage Collaborative Care to improve access to behavioral health care. In partnership with major health organizations such as CommonSpirit and AdventHealth, Concert Health has integrated remote behavioral health services with primary care, women’s health, and pediatrics — making it easier for primary care providers to deliver comprehensive care and improve clinical outcomes.

Research has shown that Collaborative Care interventions have been consistently successful in improving key outcomes in both research and clinical intervention studies. Compared to standard primary care, Collaborative care is associated with significant improvement in depression and anxiety outcomes. Additionally, the Collaborative Care model represents a useful addition to clinical pathways for patients suffering from both behavioral and physical illness.

Comorbidities have an astronomical economic and social consequence that can impact all facets of life. With greater access to whole-body health care, these consequences can be curbed, and some even avoided. All successful providers agree that proactive, preventive, comprehensive care is essential for improving patient outcomes and lowering costs across entire communities.

The editorial staff had no role in this post's creation.