The New York State Collaborative Care Initiative helped primary care residents learn how to effectively practice team-based care to treat mental health conditions, a skill that has become increasingly important as integrated care becomes more widespread. Outpatient clinics associated with teaching hospitals are implementing Collaborative Care around the state, increasing the quality of mental health care for thousands of New Yorkers. By providing different intensities of technical assistance, the AIMS Center evaluated what level of support was needed to effectively help organizations implement Collaborative Care. They helped set up a technical assistance team in New York to provide on-site assistance to six clinics. Twenty other hospital organziations received web-based technical assistance, including webinars and online tools. Organizations used a patient registry to track and measure patient goals and clinical outcomes, and facilitate treatment adjustment if a patient is not improving as expected.
Practice Type: Primary Care
Mental Health Integration Program (MHIP)
The Mental Health Integration Program (MHIP), supported and administered by the Community Health Plan of Washington in partnership with Public Health -Seattle and King County, integrates mental health screening and treatment in a collaborative care model (CoCM), including psychiatric case review and consultation. MHIP collaborative care teams in Washington State safety-net primary care settings serve diverse Medicaid and uninsured populations. Since MHIP’s inception in 2007, over 50,000 individuals have received integrated mental health services. In 2007 it began as a state-funded, two-county pilot for high risk uninsured adults in King and Pierce counties, but MHIP expanded statewide in early 2009 to include over 130 primary care clinics.
MHIP uses a patient registry (CMTS) to track and measure patient goals and clinical outcomes, and facilitate treatment adjustment if a patient is not improving as expected. MHIP also utilizes pay-for-performance mechanisms to support model fidelity and prioritize patient outcomes. Training and workforce efforts for this project focus on the whole team and all providers are trained on the fundamentals of CoCM.
Project Management
- Community Health Plan of Washington, Stephanie Shushan
- Public Health Seattle-King County, Anne Meegan
COMPASS (Care of Mental, Physical and Substance Use Syndromes)
The COMPASS (Care Of Mental, Physical And Substance-use Syndromes) initiative, funded by the Center for Medicare & Medicaid Innovation, evaluated the large-scale implementation of the TEAMcare model treating patients with depression and comorbid diabetes and/or cardiovascular disease. The initiative was implemented in 18 medical groups and 172 clinics across eight states. Participating clinics differed significantly in size, organizational structure, patient populations, and payment systems, thus demonstrating the feasibility of implementing the TEAMcare intervention in “real world” clinical settings.
The initiative involved 3,609 Medicare and Medicaid patients in eight states and is one of the largest collaborative care implementations to date. The results of the trial were published in a 2016 issue of General Hospital Psychiatry. Among patients with uncontrolled disease at enrollment, 40% achieved depression response or remission, 23% achieved glucose control and 58% achieved blood pressure control over the 11-month treatment period. There were large variations in outcomes across the medical groups, and rigorous implementation was associated with increased effectiveness. Researchers learned best practices for treating patients in primary care settings who have multiple chronic conditions, demonstrated the model can be effective for the target population when implemented well, and identified financial models that can sustain and scale a multi-condition collaborative care program.
Collaborative Care for Depression and Diabetes in India
This NIMH funded project is a collaboration between the University of Washington, Emory University and three sites in India (Chennai, Delhi, and Vishakapatnam). This grant will adapt the multicondition TEAMcare model to treat patients with poorly controlled diabetes and comorbid depression at these three sites and build on an National Heart, Lung and Blood Institute Center for Excellence grant established in India by Emory University. An initial one year qualitative study will help our research team adapt TEAMcare to the unique aspects of Indian culture and medical systems.
Link for TEAMcare: http://www.teamcarehealth.org/
Whole Person Integrated Texting for Health (WITH)
The number of older adults is rising sharply and is expected to increase from 40.3 million to 72.1 million between 2010 and 2030. According to the Pew Research Center, 92% of adults aged 65 and older use text messaging. Despite misconceptions to the contrary, text messaging as part of primary care for older adults is growing. Text messaging holds promise as a strategy for engaging older adults in Collaborative Care depression treatment through frequent contact with a behavioral health care manager. The purpose of this research project is to develop and pilot test a text messaging intervention delivered in California primary care settings serving a patient population that is at least 25% older adults. Published research (Bao et. al. 2015) demonstrated that early follow-up contact predicts better clinical outcomes for patients. A recent analysis published by the AIMS Center (Renn et. al. 2021) showed that Collaborative Care was equally effective in older and younger adults but that older adults needed more contact with the behavioral health care manager to achieve these equivalent outcomes. Text messaging may be an effective strategy for both early and more frequent contact with patients. The AIMS Center is partnering with the Archstone Foundation on this project.
Kaiser Permanente
More than 20 years of research evidence across more than 80 randomized controlled trials has established Collaborative Care as the integrated care approach with the most research evidence across all kinds of clinical delivery systems, patient populations, and geographic regions. This research evidence is replicated in dozens of peer reviewed publications evaluating implementation of Collaborative Care in real-world settings. Kaiser Permanente is committed to providing the highest quality care possible to their patients. They participated in the largest research trial of Collaborative Care and one of their regions has been practicing Collaborative Care for many years. The senior leaders at each of the eight regions, along with leadership from the national Mental Health and Wellness group, have made implementing Collaborative Care system-wide a key priority. The AIMS Center is partnering with them to accomplish this goal.
The Maternal Infant Dyad Implementation (MInD-I) Initiative
The Departments of Family Medicine and Psychiatry and Behavioral Sciences at the University of Washington (UW) are providing an opportunity for primary care providers to receive training and technical assistance to implement a Collaborative Care (CoCM) program or spread their existing CoCM services to enhance care for women with perinatal depression and other behavioral health disorders through the Maternal Infant Dyad – Implementation (MInD-I) Initiative, pronounced ‘mind eye’.
Participating care teams receive 15 months of technical assistance and training support from the AIMS Center, including assistance building patient screening and outcome reports for continuous quality improvement. Training will focus on helping primary care clinics to implement or enhance their CoCM programs and build sustainable staffing strategies. Training and technical assistance is not limited to perinatal populations. The AIMS Center staff and faculty are available to assist providers to build a robust CoCM program that can capably serve all patient populations. Care teams also receive free access to the AIMS Caseload Tracker over the course of their participation in MInD-I, with the option of continuing to use the registry afterwards by paying an annual hosting fee.
Collaborative Care for Native American Health Centers
This project is a collaboration with the Portland Area Service Unit of the Indian Health Service (IHS) and George Fox University. George Fox University received a Health Services Resource Administration (HRSA) grant to promote integrated mental health care at two Oregon sites: the Chemawa Indian School’s Primary Care Clinic (operated by the Portland Area Service Unit) and Providence Medical Group in Newburg, OR. This project creates a learning collaborative among interested IHS and tribal clinics to implement Collaborative Care. Other clinics include the Warm Springs IHS unit and tribal clinics.
The AIMS Center is providing implementation coaching support and clinician training to support the project at the Indian Health Service and related sites.
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.
CHAMP Research Study
Around 2.1 million Americans aged 12 years and older had an opioid use disorder (OUD) in 2016. Among adults who misused opioids in the prior year, 43% also had a mental illness. There is strong evidence for the efficacy of the Collaborative Care model (CoCM) in treating common mental health disorders, but not for the treatment of OUD. The CHAMP study (Collaborating to Heal Opioid Addiction and Mental Health in Primary Care) will investigate whether CoCM that addresses both mental health conditions and co-occurring OUD can improve patient lives.
The Department of Psychiatry & Behavioral Science’s Population Health Division and the AIMS Center will support up to 24 primary care clinics in implementing either CoCM for OUD and mental health conditions, or for mental health conditions only. Training for the intervention began in late summer 2020.
Find out more about this clinical trial by visiting the CHAMP website.
Contact
Lori Ferro Phone: (206) 685-7538
Email: ljf9@uw.edu
Webinar
Watch presenter Anna Ratzliff, MD, PhD give an introduction to the project and answer questions from attendees.
Video
Informational Webinar
Presentation Slides
Introduction to CHAMP