Collaborative Care Model Series - Episode 1

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Transcript

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You're listening to Vital Signs, a podcast for Sentara providers. Welcome to episode 1 of the Collaborative Care Model series.

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In today's episode, we're joined by Tommy Bateman, director of clinical practice Management, and Thomas Link,

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Director of Strategic Initiatives. Before we turn things over to the team, here are a few important CME announcements.

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This episode is accredited for AMA PRA Category 1 credits. For full accreditation,

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designation, and disclosure information, please refer to the show notes. And now here are Tommy and Thomas.

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Hello. Welcome to Vital Signs, a podcast for Center providers.

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My name's Tommy Babe and I'm your host today, and today we wanted to talk about the collaborative care model,

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which is bridging behavioral and medical health. Today we have an expert with us by the name of Thomas Link who's gonna give us a rundown over the next 4

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parts about what this is all about. Uh, Thomas, can you give me, uh, introduce yourself and give me a background of who you are and what we're

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talking about today?

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Sure. So, um, I'm Thomas Link. I'm director of strategy for Ventera and I,

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I luckily get to support all three, divisions from, acute care,

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ambulatory, and, and health plan and um focused on supporting behavioral health expansion and um within the system.

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And hopefully we're going to talk about some collaborative care, some integrative medicine, um,

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integrating physical and mental health. Um, excited to be here. Excellent,

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thank you so much for coming on today. And yes, I think your role is perfect for having an integrative,

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uh, model background. So, uh, when we talk about integrative care and collaborative care, what,

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what are we, uh, what are we talking about generally? What is that?

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Yeah, so,

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um, collaborative care

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really took off in the, the

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Uh, in the 80s and 90s, University of Washington, um in,

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in Seattle.

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Started trying to explore systematic ways to integrate behavioral health into primary care.

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Um, and, and they created this collaborative care model and it's a team-based approach,

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so it has a primary care provider, care manager who's like a licensed or unlicensed um mental health clinician and

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a psychiatric consultant, which is a psychiatrist. Um, it's focused on measurement-based care,

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so using validated screening tools, and then it's a population-based, uh,

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tracker, so they use a registry, uh, to monitor all patients.

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OK. So, take me back a little bit uh beforehand. Why, why was the collaborative care model even,

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even proposed?

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What was it what was he trying to fix? Yeah, no, I mean that's,

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so if, if we're, um, anybody listening in, you know,

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knows anything or has been a part of PCPs or primary care physicians um work flow,

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they're inundated by supporting

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mental health challenges. Um, that's not their training and specialty yet.

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Our community, what the needs in the community demands that support. We will never have enough behavior help,

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psychiatry.

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Um, providers in the communities to support the need for those communities. I mean,

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if, if you, I was talking about this the other day with, with a buddy, Doctor Dunham, and there's probably if we went across the,

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the country in every county, you know, the community needs assessment that that is completed, I guarantee you,

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um, or closely guarantee you that mental health is somewhere in the top 5 of every single county across the country and And

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what that says is that, you know, we, the service that we provide in the community doesn't match the need

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in the community. And, and so what this does is allow us to support the PCPs in managing more

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mild, moderate mental health issues. So, you know, anxiety or depression, and then if, if it's more severe.

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Um, above that moderate, then get kicked over to the referred to the, the specialist in psychiatry.

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OK, so collaborative care at first, if I may rephrase, is at first enabling PCPs to handle the,

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the, the quote unquote lower level stuff to at least get somebody in behavioral health care, um, and working together with mental health practitioners at the same

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time, or is it, uh, uh, are collaborating with other professionals at the same time?

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Yeah, yeah, OK, so think of it think of it like this is that it's essentially embedding.

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Therapist, licensed or unlicensed within the PCP practices. So if, if I go and visit my primary care physician

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and I'm struggling with depression and, you know, they have what, on average,

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7, 15 at the most, maybe 30 minutes if that's not really realistic with the patient,

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right? And, and they want to start me on a new medication and There's really not time for any kind of pharmacological education,

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any kind of diving deep into that, those mental health challenges. They,

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they can either try to start supporting some new medication to help them with depression or they can just put in a referral to a specialist,

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um, which across the board has long waits, and so what it is is the PCP can

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Uh, quote unquote refer or introduce this program that his his or her practices is supporting,

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um, introduce the care managers, what it's called, the, the licensed or unlicensed therapist, and say,

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hey, I'm going to start this medication. Uh,

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you're gonna, I'm gonna enroll you in this program and within the next couple of days, you'll have our care manager.

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Um, let's say it's, it's Tommy Bateman. Tommy's gonna reach out to you, um, and he'll help support you in this journey.

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And so then what ends up happening is that it's a team-based approach. So they hand it off to the care manager,

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the PCP and then there's a psychiatric consultant, uh, a psychiatrist that is more of a consultative model,

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um. than anything. And so that care manager would call, um,

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call me and say, hey, I saw Doctor so and so prescribed, let's say Prozac,

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some, some kind of medication, um, and

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Yeah, let me, let me dig a little bit deeper into that. It normally has a two-week um time frame for it to really get in your system and start

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feeling the effect. So it's only been a few days, so, so it's OK if you're not feeling the effect immediately.

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Um, I see that they went over your, you're really struggling with sleeping. Can you tell me more about that?

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Um, and then really solution-focused intervention. So, OK, so let's say I was,

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I'm struggling with sleeping, I've been depressed, then the care manager can say, hey, have you,

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um, you know, we talked about your dog. Have you tried going on a walk before bed with your dog or do you

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read at night? And so it's very solution focused. So let's say, uh, you know, Tommy,

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he suggests, hey, Thomas, why don't you, um, let's read at night and um And then 30 minutes before bed read

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and then, and see how that goes. Uh we're gonna, I'm gonna set up another appointment, a call with you next week and we'll talk about how this,

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these um interventions, if they're working. Also, it'll give it another week for the medication to get in your system.

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So like, you know, it's really getting in depth in the support of that patient. Now,

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During the timeframe that let's say the care manager might have 50, 75, a panel of 50,

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75 people that are enrolled, um, in that program. And so each week that care manager

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We'll be touching base with that psychiatric consultant for the support. So it really creates a triangle

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between the PCP, the care manager, psychiatric consultant, because if the medication isn't working,

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the psychiatric consultant, the psychiatrist can Make a conclusion on, hey, this isn't working and send a note to the PCP or have a

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have a brief meeting with the PCP and say, Hey, Thomas's medication, it's been 3 weeks. There's no sign of improvement.

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I think we should really try a different medication. And then the PCP can easily call in a new prescription.

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Got you. So I, I, I do see then that the care managers are able to do that follow up that the PCP just does not have the time

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or infrastructure to handle while at the same time having a psychiatrist really inform, uh,

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inform the process, but

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my, my question too is, you know, when I went to grad school.

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In integrated healthcare was one of the big topics, right? Uh, you know, what, what comes first,

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chicken or the egg? Well, sometimes it's hard to tell if the behavioral health issues driving the diabetes or if it's the uh um uh

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uh you know, the pain driving the depression. And so we had to come together as a behavioral health and medical folks to come together and see what's,

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what's really the root cause and what we can do to address it all together. But this sounds a little different.

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So, you know, it doesn't sound just integrated healthcare. What, what is collaborative care versus integrative healthcare?

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Yeah, no, it's a, it's a good, good question, so. Um, so behavioral health integration,

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traditional behavioral integration, it's really more of an umbrella statement of um integrating that physical and mental

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well-being into a one site of care delivery. Um, collaborative care is really more focused on a,

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um, the BHI, the behavioral health integration is really less structured than COCM,

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the collaborative care model, right? And so, um,

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You know, there's really normally warm handoffs in the collaborative care model. Um, it is very,

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uh, a systematic measurement-based process, um, that's focused on the population as a whole.

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So all the triggers within collaborative care are based on screening tools. So for instance,

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you could use, have a PHQ 9 score of 5 or greater, automatically qualify them for collaborative care,

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right? So then it sends it over. That's when the PCP would make the referral. Well, that care manager is going to be every touch point will be doing those

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screening tools to measure the progress. And once the progress, you know,

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University of Washington, I think labels it as like the 50% increase of, uh, really focused on the PHQ 9,

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the, the anxiety scale, but, um, or depression scale, I'm sorry, and, and they,

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um they do it as um. Measurement once they've increased or or it's decreased by

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improved by 50%, then they move them through different stages within the model, the cloud or care model until they're,

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until they graduate, quote unquote, right?

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And so, um. So I think what, what the, the conversation of, of behavioral integration really started um

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the idea of um

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Started the idea of the cloud recure model. So if you think about, let's go back to the ACA, right?

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I think it's 2010.

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It, it started highlighting the integration of behavioral health and primary care as a national priority.

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So I think of that kind of as let's really have the conversation of the behavioral health integration.

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But, but it wasn't until 2016 until when CMS really creates these reimbursement.

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Um, billing codes specific for the collaborative care model. So I think the conversation for behavioral health integration started,

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um, you know, the the geniuses that work in our field, I mean, we're surrounded by scientists and brilliant individuals started,

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hey, let's, let's think of this model that's sustainable, measured, um,

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pretty, pretty remarkable. Excellent. So that, that clarifies it. Integration is a kind of an umbrella concept,

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but cost of collaborative care model is the structured application,

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um, with a, with a uh evidence-based approach to it and and trying to measure.

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Absolutely, yep, awesome. Well, very good, and I think that is something that we're gonna be talking about in more detail in the upcoming parts,

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but right now, guys, you're gonna have to wait until part two. This is part one right now just kind of introducing us,

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but in part two we're gonna start talking about what it takes to build a successful collaborative care program. So Thomas,

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thank you, and we will talk again there shortly.

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Thank you for joining us. Be sure to keep an eye out for episode 2 of the collaborative care model series.

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You've been listening to Sentara Vital Signs, a podcast created for Sentara providers.

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As a reminder, please check today's. notes for details on how to claim your continuing education credits.

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That's it for now. But we'll be back soon with another episode of Vital Signs, a podcast that delivers evidence-based education for physicians

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and healthcare providers on the go.