A Q&A on COVID-19 and Collaborative Care with Dr. Lori Raney

The nation’s mental health crisis has been exacerbated by the COVID-19 pandemic. With additional safeguards and restrictions being implemented to contain the spread of the virus, increased experiences of depression, social isolation, and anxiety will follow closely.  

For years, healthcare experts have been working to build widespread awareness and adoption of the Collaborative Care Model (CoCM). This evidence-based model of integrated behavioral health has shown to effectively treat common mental health conditions like depression and anxiety in primary care settings.  

The demands being placed on an already strained mental health system underscore the need for an evidence based model like CoCM that helps to close the divide between mental and physical health. To get a better understanding of the pandemic’s impact on CoCM, I spoke with Dr. Lori Raney, a leading authority on the collaborative care model and the bidirectional integration of primary care and behavioral health.

Q: What kinds of obstacles, or opportunities, does the COVID-19 pandemic create when implementing a collaborative care program?

A: We keep seeing reports from the CDC and others around increased levels of anxiety, depression, stress, and substance abuse as a result of COVID-19, all of which help make an argument for utilizing the collaborative care model. Yet the pandemic makes it hard to give the proper amount of attention to collaborative care. Right now, healthcare leaders are understandably focused on PPE and staff or bed shortages; so it’s a lot to ask leadership to think of implementing a new program in the midst of such a unique time.  When we come out on the other side of this, we have to be ready to help the leaders when they are in fact ready to go.

Even beyond the pandemic, in a perfect world PCPs should be able to provide behavioral health care without having to worry about the insurance coverage of their patents.  At present, the lack of all payers reimbursing for collaborative care makes it challenging. In particular, it can be difficult to support low income, safety net Medicaid populations since we still have 35 state Medicaid agencies that aren’t reimbursing the collaborative care codes. So we have a lot of enthusiasm and energy around the model, but reimbursements and COVID can make things a bit tougher.

Q: How will health systems be able to finance collaborative care in the near term?

A: Especially for primary care practices with a limited Medicaid population, most of their patients will have commercial insurance or Medicare and many  of the commercial payers are starting to reimburse for the psychiatric collaborative care codes now.  So now you’ve got a large population that’s covered and if you’re in one of the 15 states covering Medicaid, then potentially all of your patient population will be covered. 

As such, we’re starting to see clinics that can now afford implementing collaborative care, break even with it, and even turn a profit if you’re doing it well.  The real lag comes down to state Medicaid agencies, which is a bit surprising to me as that’s where there’s such a need in this population with a multitude of co-occurring health issues. 

Q: How about from a political perspective? Given election results, can we expect big shifts to occur in the near term with regards to policy and legislation around mental health access and the collaborative care model?

A: It has been interesting to see some results where voters supported policies like Medicaid expansion whether or not the governors or state legislature wanted it. There could be some hope there, but again, it’s only if those states’ Medicaid agencies decide to reimburse those codes. Down the road, President elect Biden has expressed interest in a public option as well as potentially lowering Medicare age from 65 to 60 which would mean more patients eligible for reimbursing collaborative care through Medicare.

Q: What steps can stakeholders and leaders in healthcare take to help their organizations accelerate their path toward psychiatric collaborative care? 

A: I think there’s a few things that come to mind here. It starts with making “whole person care” part of your mission and vision for your organization.  Regardless of if you’re focusing more on the behavioral or physical side of things, it’s important to go back to your mission statement and ensure that holistic, integrated care is included.

Another key component is an effective communication strategy that starts at the top.  You need a board of directors and leaders who really understand what collaborative care means and why it’s so important.  Sometimes I do talks or presentations just for the c-suite to help them understand what CoCM is and what it is not. 

Q: Where does technology like telehealth and digital health applications come into play with regards to collaborative care?

A: I’ve been really interested in finding ways to use technology to implement or support parts of the CoCM model. For example, care managers play too much phone tag with patients to complete PHQ-9’s or follow-ups. I’m really interested in technology that can help with gathering that information from patients as well as perform other check in tasks.

What’s interesting is that there’s not a lot of need for in-person visits with  CoCM, the model was set up for phone calls and remote care; which oddly enough makes it more attractive than ever amidst stay at home orders and social distancing because of COVID.  So now, it’s about identifying the right technology to use as “practice extenders” that organizations can utilize to both overcome the difficulties of engaging around behavioral health and follow up on treatment progress in between appointments. 

Learn more about how NeuroFlow and tBHI can support your collaborative care inititaves during the COVID-19 pandemic and beyond.

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