CoCM in the Time of COVID-19

Poll suggests increased need for mental health services, experts recommend CoCM

Behavioral health conditions are expected to increase and worsen as a result of COVID-19. According to a survey conducted by the American Psychiatric Association, 36% of respondents said that COVID-19 is “seriously affecting their mental health” and most (59%) said it’s having a serious impact on their daily life (1). Primary care is likely to see many of these patients. 

Collaborative Care (CoCM) is a model for integrated behavioral health with a strong evidence base for treating common mental health conditions like depression and anxiety in primary care settings (2). CoCM has proven to be effective when delivered via telehealth, either in part or wholly (3). 

The articles below strongly advocate for the implementation of Collaborative Care during COVID-19, and call on mental health advocates to push for integrated care in primary care settings. 


Other Resources

References

  1. New poll: COVID-19 Impacting Mental Well-being. American Psychiatric Association. Mar 25, 2020. 
    View article
  2. Archer, J. et al. (2012) Collaborative care for people with anxiety and depression. Cochrane Database of Systematic Reviews. Issue 10. Art. No.: CD006525. DOI: 10.1002/14651858.CD006525.pub2
  3. Fortney, J. et al. (2013) Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. 
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816374

Innovative use of telepsychiatry in rural WA health system

After training with the AIMS Center, Columbia County Health System in Dayton, WA has built a robust behavioral health program that makes resourceful use of telepsychiatry. Read more about the care model and barriers to behavioral health access in rural communities. 

Collaborative Care Eliminated Racial Disparities for Pregnant People

A new study showed that Collaborative Care eliminated mental health care disparities between Black and white pregnant people. This study was presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting; research suggests that implementation of the Collaborative Care Model (CoCM) during pregnancy improves the screening and treatment of depression and reduces racial disparities. These findings are also published in a supplement in the American Journal of Obstetrics and Gynecology.

“In primary care, the Collaborative Care Model allows mental health care to be seamlessly integrated into physical health care,” Emily S. Miller, MD, MPH, a maternal-fetal medicine subspecialist and assistant professor at Northwestern University, said in a press release. In the field of obstetrics, however, this model is not often utilized.”

Researchers analyzed data from 4,710 pregnant and postpartum people who self-identified as either Black or white. Individuals were divided into two groups: Before and after implementation of CoCM with results analyzed by race. The primary goal of the research was:                                                                                                                                                                                                                                                                                             

  1. Evaluate how often pregnant people are screened for depression.
  2. When a pregnant person screened positive for depression, determine how often treatment was recommended.

The study found that after CoCM was implemented, mental health disparities between Black and white populations were eliminated. Similarly, for pregnant people who screened positive, implementation of CoCM was associated with elimination of racial disparities in the recommendation of treatment. 

 

According to the article, researchers state the next step is to implement CoCM in obstetrics care across the United States to help improve health outcomes for pregnant people with depression.

 

Collaborative Care Eliminated Racial Disparities for Pregnant People

 

The abstract has been published in the January 2022 supplement of the American Journal of Obstetrics and Gynecology (AJOGand can be accessed at no cost. To view the presentation of this abstract or other Pregnancy Meeting™ abstracts and events, visit the SMFM website or contact Karen Addis at karen@addispr.com or 301-787-2394.

Health Plans Promote Collaborative Care

Two health plans share their experiences implementing Collaborative Care in a recent article in Psychiatric News. More than eighty published studies have shown that the Collaborative Care Model CoCM lowers the cost of care and results in better patient outcomes. While implementation of CoCM continues to gain momentum nationally, widescale implementation remains slow. The reasons for this include the challenges with implementing any practice change in the busy world of primary care, the start-up costs associated with implementing CoCM before a full caseload is realized and the program is self-supporting, and behavioral health workforce shortages.
 
To alleviate these barriers, Psychiatric News interviewed medical directors from two health insurance plans that have taken the reins to help primary care practices transition to CoCM by providing training, coaching, provider incentives, and access to CoCM vendors, one of which includes an AIMS Center project: Premera. 

“Spurred by a significant shortage of mental health clinicians in its vast two-state territory of Washington and Alaska, Premera Blue Cross is investing $10 million for up to 30 rural primary care clinics to implement collaborative care. The AIMS Center at the University of Washington is providing training, coaching, and oversight for the practices.”

“”It’s the right thing to do,” Susanne Quistgaard, M.D., medical director of Provider Customer Engagement at Premera Blue Cross, said of the grants. “We care about the communities we serve.” The AIMS Center will train up to 10 practices at a time, and the first group of PCPs began using CoCM in their practices about a year ago. They have enrolled more than 1,300 patients in treatment thus far.”

Health Plans Promote Collaborative Care

CoCM as Effective for Treating Bipolar Disorder & PTSD as Specialty Care

A new study published in JAMA Psychiatry shows that Collaborative Care (CoCM) for bipolar disorder and/or PTSD is just as effective as treatment provided by a psychiatrist and psychologist. Both Collaborative Care and specialty mental health care were delivered by telemedicine to patients in federally qualified health centers. As stated in the article, “Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months.”

While a handful of other studies have examined Collaborative Care for bipolar disorder or PTSD, this is the first study that directly compares Collaborative Care to specialty mental health care. 

Collaborative Care Rises to the Pandemic Challenge

As the pandemic heightens the demand for mental healthcare, experts are pushing for the adoption of scalable, evidence-based integrated care models like Collaborative Care. An article in Psychiatric News states that “CoCM is the only model that bundles all integrated services – including the psychiatric case review and recommendations – and is reimbursed by insurance; it is also the model with the most extensive evidence base for improved outcomes.”

 Collaborative Care Rises to the Pandemic Challenge

CoCM-Driven Solutions to COVID-19 Mental Health Challenges

The COVID-19 pandemic poses unique (and reinforces long-standing) barriers to mental health access; yet, the demand for mental health services continues to increase. The Collaborative Care model (CoCM) offers a way to more efficiently leverage mental health expertise over broader service areas and patient populations, while utilizing the clinical reach and established telemedicine programs in primary care settings. The article below, published in JAMA Psychiatry, further outlines the needs for and benefits of CoCM in the COVID-19 era. 

Harnessing Collaborative Care to Meet Mental Health Demands in the Era of COVID-19

Anna Ratzliff CoCM Testimony to US Senate Committee on Finance

The power of CoCM was testified to by Anna Ratzliff  before the US Senate Committee on Finance, highlighting its ability to leverage scarce psychiatric resources to treat a large number of patients in primary care and to get more patients better faster than usual primary care, even when usual care includes embedded psychotherapists. Her testimony was included in the third of a series of hearings on mental health titled, “Behavioral Health Care When Americans Need It: Ensuring Parity and Care Integration.” This third hearing served as a follow-up to the committee’s Feb. 8 and Feb. 15 hearings on youth mental health.

In her testimony, AIMS Center Co-Director Dr. Ratzliff underscored the need for continued investment in care models that promote the integration of physical and behavioral health care. Dr. Ratzliff highlighted the potential of CoCM to increase access to timely and appropriate behavioral health care:

“This model is evidence-based with over 90 validated studies showing its effectiveness and has been recognized by the Centers for Medicare and Medicaid services with specific billing codes that were introduced in 2017.”

 “CoCM leverages expertise like mine, as a psychiatric consultant, to support 60 to 80 patients in as little as 1 to 2 hours a week.”

“I think many of my patients commented on that fact that they didn’t have to manage that communication between their different providers when that service was all offered together in one setting.”

CoCM is a team-based approach and can effectively expand access to mental health and substance use disorder treatment, especially for communities that have lacked equitable access such as rural and underserved populations, BIPOC communities, Medicare/Medicaid patients, and youth populations. Dr. Ratzliff outlined specific policy recommendations to encourage the widespread adoption of CoCM, including additional funding to support implementation at the practice level, the elimination of patient cost sharing under Medicare, and increased reimbursement through existing Medicare Current Procedural Terminology codes.

The United States continues to suffer a profound crisis when it comes to mental health care. You can read more about the state of mental health care in America and find out what’s being done about it on a national level in: Mental Health Care in the United States, the Case for Federal Action.