Erin Hafer is the Manager of New Programs Integration at Community Health Plan of Washington, a not-for-profit organization founded by local community health centers. Over the past six years, she has overseen the implementation of Collaborative Care in nearly 150 community health centers across the state of Washington as part of the Mental Health Integration Program. Erin recently spoke to us about her experiences.
Q: Can you tell us how Collaborative Care makes sense from a business perspective?
We see it as an opportunity to improve access to services for our patients who are engaged in care, especially those who have complex, chronic medical conditions. I think it’s also a good way to improve access to a scarce psychiatric resource, or limited psychiatric resource, and a good way to spread those limited resources on a broader scale.
Q: Tell us about some of the challenges you’ve seen in implementing Collaborative Care.
Some of the challenges we’ve experienced in implementing Collaborative Care have really focused on practice transformation. It really involves delivering care in a different way and requires additional training support, and from a health plan perspective, putting the appropriate treatment mechanisms in place — wrapping around the care team and making sure care is delivered in a way that supports improving the care of the individual.
Q: Any challenges that were just hard to overcome?
One of our main challenges was really figuring out how the care team can best function together, and that involves really making sure that each team member is equally contributing to the process. What we’ve found over time is that it’s not necessarily about the credentials of the individual providing the Collaborative Care model, but also their ability to work and function as a team. So, many of our more successful sites have had those well-functioning teams. One of our main challenges is separating out what’s the difference between just a co-location of physical health and behavioral health and actually working as an integrated team.
The model has really helped us in terms of provider satisfaction as well. Being a member of an integrated care team is a good learning opportunity; it’s a way to develop staff and we’ve really seen that some of the participants who have been involved in the model value that level of collaboration with the other team members and then also with other care teams across the state.
Q: Accountability is one of the five core principles of Collaborative care. Can you talk about how Collaborative Care helps providers, clinics, and CHPW be accountable for clinical and financial outcomes?
Being a health plan that serves publicly funded programs, transparency and accountability is incredibly important. One of the benefits of the Collaborative Care model is that we have real time transparency in terms of outcomes. As a health plan, we’ve also been able to incentivize the core components of the Collaborative Care model and offer pay-for-performance incentives to really focus in on making sure we’re measuring clinical outcomes and incentivizing them. And based on those incentives, we’ve been able to see an improvement in clinical outcomes for mental health conditions, including depression, anxiety, and every broader mental health conditions more rapidly. We’ve actually seen that by incentivizing those outcomes, the time to improvement can be dramatically reduced by up to 50 percent.
Q: Can you talk about how this approach helps you achieve the Triple Aim of health care reform?
The Collaborative Care model helps us achieve the Triple Aim because it is focused on improving patient experience, improving clinical outcomes, and also reducing cost. We’ve seen all of those achieved in using the model. Specifically on improving or reducing costs.
In my experience implementing Collaborative Care on a smaller scale pilot and now a statewide program, we’ve really seen how having those clinical outcomes and cost reductions has helped to support wide-scale adoption Initially, we had to prove some of those components, and now that we have that experience, adoption has been a lot easier. I think we’ve also been able to fine tune some of the tools we use to help get teams onboard, in terms of how they can adapt their current processes to more of a Collaborative Care model.
Q: Have your outcomes been consistent?
I think we expected initially to see a great deal of variation in some of the outcomes across the state and across sites. But, if we focus on the core principles of Collaborative Care, we’re able to get to consistent outcomes in both rural and urban settings across Washington State.
Q: What has your feedback been from other providers?
One of the most important things I’ve heard from providers about the Collaborative Care model is just the level of satisfaction and being able to see clinical outcomes improve, and improve fairly rapidly, compared to usual care. That has been tremendous in terms of being able to get provider buy-in because the satisfaction of being able to see patients improving creates a great deal of support for the program. Our clinics serve a safety net population with a huge variety of mental health conditions including depression,anxiety, PTSD, and bipolar, and they also serve a very diverse population. So, what’s been really great is to be able to see that the same principles that apply to depressed elderly, adults — the population in the original IMPACT trial — has also been beneficial to the safety net population that we serve.