Answering Common Questions on Collaborative Care (CoCM)

With rising rates of depression and anxiety across the country, health systems are seeking a comprehensive solution to address mental health. These strategies often include implementing a behavioral health integration (BHI) program, but as health systems and payers encounter the influx of patients requiring mental health services, they must consider the Psychiatric Collaborative Care Model (CoCM) as a potential part of the solution. 

Over the past 20 years, the Collaborative Care Model (CoCM) has been extensively studied and has proven to improve patient outcomes, lower total costs of care, and deliver better care at scale. But the journey towards implementing CoCM is not a linear one – it requires a substantive change in the organizational culture and a holistic integration of mental health services in a patient population with co-occurring physical health needs.

When done properly, CoCM should empower a patient’s primary care provider to deliver better care without additional time and administrative burdens. The program should also be at least cost-neutral for health systems through the utilization of billing codes. To do this, the program must be efficient and ensure that patients are being enrolled to keep the registry (the system where the program caseload is maintained) full.

The overarching goal of CoCM is to cost-effectively improve health outcomes by connecting four components—patients, medical providers (such as primary care providers), behavioral health care managers, and psychiatric consultants. To help break down how these different components work together to bring CoCM to life, we’ve compiled answers to a few of the most commonly asked questions to help hopsitals and health systems considering deploying CoCM:

Q: What “foundational” components are necessary for a CoCM program?

A: The Collaborative Care Model is made up of five required components detailed below: 

  • Patient-Centered Team Care: A non-behavioral health physician (traditionally a primary care physician, but can be another specialist) and a behavioral health team comprised of a behavioral health care manager and a psychiatric consultant share and collaborate on everything from assessments and treatment plans to medication regimens and patient goals.
  • Population-Based Care: Every patient is tracked in a specific real-time registry so no one slips through the cracks, and they require at least a monthly follow-up to adjust treatment plans as appropriate.
  • Measurement-Based Treatment to Target: Treatment plans and outcomes are measured by validated rating scales (assessments), like the PHQ-9 depression scale, to reach a targeted goal.  
  • The Right Level of Evidence-Based Care: A key tenet of CoCM is getting the right patients to the right level of care – in other words, not every patient that has depression needs to see a psychiatrist for medication. 
  • Accountable Care: Depending on the payer and the agreed upon value-based care arrangement, providers are commonly rewarded for the quality of care and outcomes, not just the volume of patients they treat.

Q: How can my health system ensure its CoCM program is both evidence and measurement-based?

A: Decades of research and over 80 randomized controlled trials have shown that CoCM is more clinically and financially effective when compared to standard care. Additionally, CoCM is recognized as an evidence-based best practice by federal agencies (CMS, SAMHSA, AHRQ) and leading mental health organizations, such as the American Psychiatric Association

Treatment plans and outcomes are measured by validated assessment tools such as the PHQ-9 depression scale and the GAD-7 anxiety score. As a result, providers can reliably measure outcomes over time and use that insight to adjust treatment as needed.  In an effective CoCM program, behavioral health care managers perform four tasks each month: 

  1. Brief interventions, such as goal setting and behavioral activation
  2. Outcomes measurement, such as using the PHQ-9
  3. Case review with the psychiatric consultant
  4. Providing other care management services, which in addition to above, may also include support such as directing patients to community resources to address social determinant needs. 

Q: What tips do you have on making sure the program is patient-centric?

A: CoCM programs are inherently patient-centric. Treating behavioral health care in the same setting as primary care is proven to increase patient engagement and lead to a better healthcare experience. The key is to empower patients to set goals for themselves, and to make sure those goals are communicated to every member of the care team. For patients, goals should be about improving their lives—not just their diagnosis.

Patients work directly with their behavioral health care managers to set their personal goals so that clear communication is formed at the onset of the program. The care manager discusses the patient’s desires with the psychiatric consultant who then uses this information to provide patient-focused recommendations to the medical provider. 

Patients are also encouraged to stay in the center of their care by tracking their own data on their own personal devices and seeing their improvement over time. With tech-enabled CoCM tools, patients can visualize their gains for a powerful sense of achievement.

Q: What specific changes in providers’ care processes should we expect?

A: Building out a CoCM program is not meant to overburden care providers. It is intended to make sure that the right care team is in place to optimize patient outcomes. For far too long, “collaborative care” has meant medical providers and behavioral health providers passing sticky notes to one another while passing in the hallway.

Today, behavioral health care managers and psychiatric consults can use cloud-based registries not only to communicate with each other, but also to inform medical providers of recommended changes to a treatment plan. This can be via integration of the registry and consultation notes directly into the EHR, through EHR inboxing, or whatever communications the team currently uses in their clinical workflow.

Q: How can my health system ensure patients are well-informed about CoCM?

A: Upfront patient education is critical to successful CoCM implementation. Educating your patients with a digital, self-serve curriculum, for example, can make the transition easier. One key piece of information to communicate with your patients is that their trusted medical provider will remain in charge of their care.  The added care team members—the behavioral health care managers and psychiatric consultants—are simply there to provide extra support throughout their care journey.  

Learn more about CoCM and how NeuroFlow can support your organization here.

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