Collaborative Care: Paying for What Works
When people aren’t feeling well, they typically visit their primary care office. It is a familiar setting and if specialty care is needed, a referral is provided. The same should also be true for mental health conditions like depression, substance use disorders and anxiety. Yet, getting a referral for specialty mental health care can be challenging and many who get a referral do not access care1. This happens because of stigma, a shortage of mental health providers, lack of adequate insurance coverage and lack of engagement in treatment.
As shown in the diagram below, half of those referred do not connect with care. The average number of visits is two for those who receive care.
This is costly for employers. Depression costs employers an estimated $44 billion each year in lost productivity.2 About half of employees with depression are untreated. Yet with proper treatment, most people with depression get better. The key is to help employees access effective care.
What is Collaborative Care?3
Collaborative care is an effective integrated care treatment model that produces positive results. It provides holistic care by delivering both medical and mental health care in primary care settings. This works well for people with common mental health conditions like depression and anxiety, as well as substance use disorders, by offering convenience with one stop healthcare in a familiar setting.
Here’s how it works. Collaborative Care uses a multi-disciplinary team of healthcare professionals. The team is led by a well-trained primary care provider and includes a care manager, along with a psychiatric consultant and frequently other mental health providers.
The Collaborative Care Model uses measurement-based care (MBC) that includes validated symptom rating scales for making treatment decisions, monitoring progress and making needed treatment adjustments. It also allows providers to report on treatment outcomes. Using rating scales better engages people in treatment, helps them better understand their care and leads to better outcomes . People get better faster. With more than 80 studies supporting its use, this model of care is more effective than usual care4.
Usual Care and the Collaborative Care Model
As the diagram shows, with usual care, a person experiencing a condition like depression seeks care from their primary care provider (PCP) and then receives a referral to a psychiatrist or other mental health specialist. This may or may not lead to care. In contrast, with the Collaborative Care Model, a person with depression starts with either a PCP or care manager trained in delivering effective care for depression. The care manager coordinates care between the individual, PCP and psychiatric consultant. Telepsychiatry may also be used in under-served communities. Key components of the model include:3,4
Care coordination and care management
Care monitoring and treatment using validated rating scales
Case reviews, consultation and treatment adjustments
Measurable and reportable on treatment outcomes
How Does Collaborative Care Help Employers?
The Collaborative Care Model is more cost-effective than usual care. When Collaborative Care is implemented, employers could see a combined cost savings of $1815 per employee per year in health care expenditures and increased productivity.5 On a national scale, implementing Collaborative Care results in a reduction in healthcare spending of 5-10% and potential cost savings of $26 to $48 billion per year.6 This data provides clear justification for employers to ask their health plans to ensure providers in their networks are trained and offering the Collaborative Care Model to enrollees.
Tips for Employers in Promoting Collaborative Care
Talk with your health plan. Use this information to talk with your health plan about the care being delivered to employees. Here are some possible questions:
What percentage of primary care offices in your network are trained in and providing the Collaborative Care Model for conditions like depression and anxiety for our employees?
What data do you have available to show the treatment outcomes achieved in primary care offices using the model?
Ask your health plan to turn on billing codes. Request that your health plan use the Collaborative Care billing codes to reimburse providers in delivering this effective model of care. Collaborative Care works and should be promoted and paid for by health plans with providers in their network.
Promote the importance of the Collaborative Care Model with your employee assistance program (EAP). Work with your external EAP vendor and in-house EAP staff to ensure they understand Collaborative Care and are sharing information about this care model with employees seeking help for mental health conditions commonly treated in primary care like depression and anxiety.
Implement Health Risk Assessments (HRAs) that include mental health questions. Be sure to use HRAs with questions on stress, depression and substance use disorders to gather useful mental health information. For employees who screen positive, provide them with information on effective care models like collaborative care, EAP options and mental health benefits.
Find out if and how your employees and their dependents are currently screened for depression. Screening should be included in health risk appraisals, offered by your health plan as part of routine primary care, offered through EAPs and as part of the disability management process. Employees should also be informed of free online depression screening, like depression screening offered by Mental Health America.
Share information about mental health benefits and resources with employees. Share easily accessible resources and information with employees about effective treatment models for common mental health conditions like depression and anxiety, including collaborative care.
As healthcare purchasers, employers have tremendous leverage to improve the quality of mental health care delivered to employees and their families. Asking questions and engaging health plans on mental health treatment and outcomes, will lead to greater accountability in delivering effective care. It also promises employers a higher return on their healthcare investment.
American Psychiatric Association: What is the Collaborative Care Model and more resources
Advanced Integrated Mental Health Solutions: The AIMS Center and Collaborative
Ewuria Darley, MS, associate director of the Center for Workplace Mental Health
Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of General Internal Medicine 17 (4): 258-69.
Cost of lost productive work time among US workers with depression. JAMA. 2003; 289:3135-44 Grembowski, D. E., D. Martin, D. Patrick, P. Diehr, W. Katon, B. Williams, R. Engleberg, et al. 2002.
John C. Fortney, Ph.D., Jürgen Unützer, M.D., M.P.H., Glenda Wrenn, M.D., M.S.H.P., Jeffrey M. Pyne, M.D., G. Richard Smith, M.D., Michael Schoenbaum, Ph.D., Henry T. Harbin, M.D., A Tipping Point for Measurement-Based Care. Psychiatric Services. Published online: September 01, 2016.
University of Washington, AIMS Center.
Unűtzer J, Katon W, Fan M-Y, et al. Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care. 2008 Feb;14(2):95-100.
Melek, S., D.T. Norris, and J. Paulus, Economic Impact of Integrated Medical-Behavioral Healthcare. Milliman, 2014.