Psychiatric Collaborative Care, Made Easy

NeuroFlow’s market-leading solution provides the technology and staffing to successfully implement sustainable collaborative care at scale

Make the Collaborative Care Model Work for your Business

The Psychiatric Collaborative Care Model (CoCM) is the most effective evidence-based integrated care model for behavioral health, validated by more than 90 randomized controlled trials. CoCM enables a holistic team-based approach to treating common mental health conditions by integrating behavioral health professionals into the care team, while simultaneously increasing the confidence and competence of physical health providers in treating these disorders.

While the clinical effectiveness of CoCM in managing higher acuity patients is backed by years of research, it traditionally comes with high costs and a long ramp-up time. NeuroFlow’s solution for CoCM combines technology and services to drive results quickly and cost-effectively.

 

How PASS saved $264K and helped 72% of patients achieve depression response in just six months

“We can risk-stratify our population and better understand our patients’ varying risk levels, which allows us to proactively adjust treatment plans where necessary.”

-Sudhir Rao, M.D., Pain and Spine Specialists

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CoCM the Usual Way

Implementation and scaling of services is impeded by challenges in hiring  behavioral health care managers and psychiatric consultants.  Staffing is expensive and difficult due to provider shortages, training, and ramp up.

Manual referral processes impede filling CoCM caseloads, causing behavioral teams to be underutilized and creating financial burden to the organization.

Static tools like spreadsheets serve as the home for patient tracking and management, making collaboration difficult and scaling inefficient.

Paper-and-pencil approach means PCPs are manually uploading assessment data to EHRs and reviewing treatment recommendations outside their usual systems.

CoCM the NeuroFlow Way

Staffing support with experienced behavioral health care managers and psychiatric consultants takes burden off your teams and allows for immediate implementation and scaling. 

App-based remote universal assessments rapidly identify CoCM-appropriate patients, and targeted bulk patient invitations fill your caseload from day one.

Our cloud-based registry enables real-time collaboration and management of your patient panel with straightforward time-tracking and documentation, making scaling your CoCM program easier and more efficient.

EHR integrations and comprehensive reporting keep PCPs informed within their existing workflows.

25%

increase in caseload capacity

12%

reduction in time to response

90%

care team satisfaction using NeuroFlow

*NeuroFlow measures clinical and engagement outcome metrics as evidence for the efficacy of our solution, based on internal data (n>146,000)

Health First is Succeeding in CoCM with NeuroFlow

“The last thing I wanted to do was to have a patient in a waiting room fill out a screening tool, give it to someone at the front office, have them score it, enter it into the EHR, and then expect the PCP to see that before they go in and meet the patient…Now we are doing outreach to 30,000 people which helps us identify people who actually meet the criteria for treatment before they come into the office, which is ideal.”

– John Eiler, System VP of Behavioral Services at Health First

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See below for some helpful responses to FAQs on collaborative care

Collaborative care is a model of integrated care that was developed at the University of Washington AIMS Center to treat mental health conditions like depression and anxiety which require regular follow-up due to their persistent nature. Collaborative care focuses on defined populations that are tracked within a registry and leverages a care team made up of primary care providers, behavioral health care managers, and psychiatric consultants, who provide evidence-based, brief interventions and prescribe medication when necessary.

Over 90 randomized trials have proven collaborative care to be one of the most effective ways to treat diverse populations that have a variety of behavioral health and comorbid medical conditions, enhancing both mental and physical well-being.

Collaborative care requires new workflows and team members. In a typical medical care scenario, the treatment team has two members, the primary care provider (PCP) and the patient. In collaborative care, there are two additional roles, the behavioral health care manager (BHCM) and the psychiatric consult. These additional care team members are critical for closing the gap between physical and mental health care, ensuring behavioral health conditions are not left untreated as is often the case in primary care settings.

The primary care provider determines whether the patient should be enrolled in collaborative care based on behavioral health symptoms, medications needs, or the patient’s level of support. Treating behavioral health conditions in a primary care setting improves access for patients who already have an existing relationship with their PCP.

The PCP then introduces the patient to the BHCM who will conduct regular, brief interventions with the patients. These interventions include conducting validated assessments like the PHQ-9 for depression or GAD-7 for anxiety as well evidence-based therapies like cognitive-based therapy (CBT).

In addition to communicating with the PCP and patient regularly, the BHCM also works with a psychiatric consultant to determine prescription needs and adjust the care plan based on patient outcomes. The care manager and psychiatric consult collaborate through a patient registry to effectively manage the patient caseload and monitor the population. This workflow makes it easier to identify, treat, and monitor patients who have behavioral health conditions within a primary care setting and drives significantly improved outcomes. In the groundbreaking IMPACT Study, collaborative care doubled the effectiveness of depression treatment for older adults in the primary care setting.

According to the University of Washington AIMS Center, there are five core components of the collaborative care model, and each element must be in place in order to deliver effective care to the patient population.

Patient-Centered Team Care

The patient must be at the center of the care team to deliver high-quality collaborative care. Providing both physical and mental health care through a single care team is comfortable and convenient for the patient and improves engagement. Greater patient engagement leads to a better health care experience and improved patient outcomes.

Population-Based Care

Collaborative care is delivered across a population to ensure no individual falls through the cracks. A patient registry enables care teams to track every patient in the population and identify when behavioral health conditions worsen and regular interventions are required.

Measurement-Based Treatment to Target

Also known as stepped care, measurement-based treatment to target means that patients have a specific goal or clinical outcome to reach through collaborative care, such as a score that’s 10 or lower on a PHQ-9 assessment. Treatment plans are measured against those results and change if a patient’s behavioral health is not improving.

Evidence-Based Care

Collaborative care provides treatments that are backed by credible research, including evidence-based therapies like cognitive-based therapy (CBT) and problem-solving treatment (PST). The care manager delivers these therapies in the form of brief interventions, taking the burden of care off the PCP.

Accountable Care

Collaborative care can be billed through a fee-for-service arrangement using CPT codes. CoCM is also compatible with a value-based care billing model. In that arrangement, providers are reimbursed for the quality of care and clinical outcomes, not just the volume of care provided.

CoCM programs are inherently patient-centric because they are proven to increase patient engagement by treating physical and behavioral health together. Providers 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.

A patient-centric program should also provide behavioral health resources, such as digital health content, that patients can explore outside of a healthcare setting. Some collaborative care technology solutions offer patients tools to track their well-being or self-guided dCBT curricula. These collaborative care platforms provide diverse options for patients to manage their behavioral health in a way that works best for them.

Implementing collaborative care requires significant upfront investment of time and resources to establish new workflows, train staff, and invest in the technology necessary to manage population-wide data. The right technology can streamline workflows and create the necessary connections between an EHR and the patient registry so that no patient is overlooked.

Technology can also empower care teams to deliver assessments and treatment remotely to a much larger population and personalize care plans based on patient engagement and scores. For example, a digital collaborative care solution can quickly identify an individual’s depression symptoms, flag that patient in the registry for the care team, and immediately deliver customized depression content so that the patient receives timely support.

After a patient completes collaborative care, behavioral health technology can continue to engage that patient with evidence-based content and monitor well-being over time. This is incredibly valuable if a patient relapses in between primary care visits. When a patient’s well-being declines, the primary care provider is alerted immediately, and the patient receives the appropriate level of care before symptoms worsen.

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