Social Innovation Fund: Healthy Futures

IMPROVING DEPRESSION CARE IN THE RURAL WEST: SOCIAL INNOVATION FUND

Poor mental health is a major public health issue that robs millions of people of their chance to lead healthy and productive lives. Depression alone doubles overall healthcare costs, worsens other medical conditions, and results in a staggering loss of productivity at work. In underserved rural areas in the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region, a severe shortage of mental health providers compounds these problems.

Through a public-private partnership, the AIMS Center supported eight rural community primary care clinics serving low-income patients to implement collaborative care (also called collaborative care management or CoCM) in the WWAMI region, a geographic area served by the University of Washington School of Medicine and representing 27% of the land mass of the United States. These 8 clinics planned to serve 3,250 patients but ultimately enrolled 5,392 patients. This represents 16% of the total unique patients served by these clinics and is a significant increase of the patients they were able to reach before implementing CoCM.

Read: One Clinic’s Story.

New York State Collaborative Care Medicaid Program

Developed in 2015, the Collaborative Care Medicaid Program (CCMP) is a state-based program to help clinics fully integrate behavioral health screening and treatment into primary care settings and to provide reimbursement for those services. CCMP grew out of a New York State Department of Health grant-funded demonstration program called the New York State Collaborative Care Initiative, which ran from 2011 to 2014. Having demonstrated robust feasability and acceptability, along with improved clinical outcomes during the grant period, the New York State Office of Mental Health (OMH) was able to secure legislative funding for the creation of the CCMP. CCMP was the first Medicaid program in the country to provide reimbursement for Collaborative Care services for adult depression. Anxiety diagnoses (including PTSD) were later added to the Medicaid payment, as well as a lower age threshold of 12 years. Another unique feature to the Medicaid payment structure is the Quality Supplemental Payment (QSP) payment, which gives some clinics the opportunity to get an additional payment by achieving quality outcomes.

Now, over 200 clinics participate in CCMP, receiving free training and technical assitance from the AIMS Center and Concert Health, as well as discounted access to the AIMS Centers’ Care Management Tracking System registry and discounted training in Problem Solving Treatment therapy. Part of participation requires the submission of quarterly process and outcomes data to OMH, which is used to further improve the training and technical assitance offered to CCMP clinics.

New York State Learning Network

The New York State Office of Mental Health (OMH) asked Performing Provider Systems (PPSs) from all over the state that chose Collaborative Care for their Delivery System Reform Incentive Program (DSRIP) to nominate at least one of their clinics to participate in the Learning Network. Through a rigorous application process, 19 clinics were selected to participate. As a part of the Learning Network, these clinics will eventually be eligible to bill the monthly Medicaid case rate once they are trained and have the necessary staffing, infrastructure, and workflows in place to deliver effective Collaborative Care (CoCM).

In order to achieve these goals, OMH provided clinics with training, site visits, and access to tools that facilitate the implementation of Collaborative Care, including access to the AIMS Center’s Care Management Tracking System.
While Collaborative Care training and support provided by OMH is only available to these clinics for one year, OMH hopes that creating a network of clinics learning together will facilitate the success of Collaborative Care for clinics beyond additional training support. As part of the Learning Network, clinics are encouraged to build relationships with the other clinics through communicating and learning from one another along the way. Individual clinics are matched with similarly structured clinics to form several training cohorts to better facilitate learning. An experienced coach works with each training cohort throughout the implementation process. Regular calls with the training cohort will keep clinics connected and provide the opportunity to receive additional training support, discuss challenges, and learn what the other sites are doing.

The AIMS Center, NYS OMH, Qualis Health, and, most importantly, the training cohorts will provide clinics with the support and tools needed to ensure a successful CoCM program implementation. We hope that each clinic’s care team will continue to communicate with the other members of the learning network after the close of the year and the discontinuation of services.

Care Partners: Bridging Families, Clinics, and Communities to Advance Late-Life Depression Care

Through Archstone Foundation’s Depression in Late Life Initiative, the Care Partners project seeks to improve depression care for older adults by building innovative and effective community partnerships. Specifically, the Care Partners project has the following goals: 1) develop late-life depression innovations among primary care, community-based organizations (CBOs) and family, 2) build a learning community of clinics, CBOs, and researchers in California who will work together on the Care Partners Late-Life Depression Initiative to improve care for depressed older adults, 3) conduct an evaluation of the developing models, and 4) develop and conduct a Learning Collaborative in Year 5 for California clinics and CBOs interested in improving depression care for older adults. Throughout the project, project teams at the University of Washington (UW) and UC-Davis (UCD) provide technical assistance and evaluation to support site development and sustainment. Together, the community-engaged partnerships have tremendous potential to improve access to care, patient engagement, patient care experience and quality of care. In addition, CBO and clinic partners are well primed to improve care through addressing the social determinants of health.