Collaborative Care Model Series - Episode 2

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Transcript

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You're listening to Vital Signs, a podcast for Sentara providers. Welcome to episode 2 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 one credits. For full accreditation,

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designation, and disclosure information, please refer to the show.

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And now here are Tommy and Thomas.

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Hello and welcome and welcome back to Vital Signs, a podcast for Sentara providers.

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My name is Tommy Bateman, and uh today we're gonna continue our behavioral health series about the collaborative care program.

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This is part two of the collaborative care program or model uh uh talk with Thomas Link.

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If you haven't heard part one, go back a week and you will find it there where we will introduce the topic.

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So, Thomas, thank you for coming back. In this part we wanted to talk about what does it take to make a successful collaborative care model

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work in a practice. So now that we understand what the model is generally, what is it like in the real world?

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We can talk about the model, the ideal model, and all that stuff, but things get messy when people get involved in structures and buildings and paperwork and EMR and

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all that sort of thing. So, uh, kind of run me through what it takes to just even set it up.

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Yeah, so

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I'm glad I'm back here with you. I think this is an important topic to talk about, um.

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To, to really put this into practice, um, what is really needed.

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Um, it's buying from a system level, right? I mean, if, if you go and we go to talk to primary care

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physicians, um,

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you know, the, I mean,

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You know, you think, think about it, 60 or 70% of antidepressants are prescribed in primary care, right?

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So I mean, you know, the majority is being

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supported by the PCP. So if you go and talk to a group of PCPs about their experience with mental health challenges and,

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and patients that are struggling with mental health,

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they want support, they need support. They're willing, but now you have to think about this though.

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And, and at least this has been my experience. PCPs are asked to do everything.

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I mean, you know, it, it is, it is very um

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Jarring

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for us to continue asking PCPs, we need more from you. We need more from you instead of,

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hey, how do we support you in a meaningful way um to really start supporting the wellness of a community versus just being,

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um, you know, supporting more of acute care needs when somebody's only sick. And so,

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um, so that's the first thing. So you have to have a system level, uh, Approach,

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meaning like you have to have executive buy-in um if it's a smaller practice, uh,

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it's, it's normally easier to implement um versus a larger health system and

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You know, and you're gonna have to, you're gonna have to hire somebody, a case manager,

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you're gonna have to develop a relationship with a psychiatrist or a psych practice or maybe even hire one for your practice,

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so that that's, that is system level decisions at that point. So I can see why you need to buy in.

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Yeah. Yeah, and then, and then, you know, really socializing it and, and um creating your,

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uh your change team on integrating these, these care managers,

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the licensed or unlicensed therapist, um, you know. Into these PCP practices.

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And so once you start having the buy-in and now with the you mentioned EHR systems,

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I mean that's a whole another animal. when this first started rolling out, it was, and even today still,

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people are just using Excel spreadsheets for the registry, you know, you just have a list of your patients as a care manager,

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you have a list of your patient panel, um. They're kind of going across the spreadsheet,

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their PHQ 9 scores or GAD 7 scores or whatever screening tool, the program itself is using,

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and you know you're tracking and trending the progress of each of your patients that are on the panel now with the EHR system.

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I mean there's the, there's the, the, the opportunities really endless with creating a registry and referrals and notes

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and so that that's going to be individualized for whatever vendor you have as a,

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as a EHR system, right? So Epic or Cerner or whatever it might be, um.

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So going beyond that, right, let's say you identified a psychiatrist that's excited to support this

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program, you have PCPs that are buying in, and then you go and buy, hire a care manager and integrate a man,

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right? Um.

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It hinges on the, the engagement for this program hinges on how uh the care manager.

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is embedded into those those practices, meaning.

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Like that care manager is vital that they are a part of that team. They, you know,

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ideally they're on site, you know, these days after COVID, it's so much, so many things are virtual and ideally you have them on

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site and they're part of that team. It, it, they create

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a situation where they are um indispensable, right? I think that's kind of the goal.

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And, and it is all about the engagement from the care manager and the PCPs, right? So the,

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the, the psychiatrist and the PCP they'll, they'll rarely have much um one on one face time

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just because of the nature of the program, right? So the PCP will put in a console or a referral over to the,

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the care manager that's

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Deely in the practice physically where they could actually walk them down the hall and say, hey,

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let me introduce you to Tommy. He's our care manager. He leads our, our collaborative care model.

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This is what that means, right? And then it's a, it's a smooth handoff. Um,

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that's the ideal state. Um, now, scaling this, that's, that makes it challenging,

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right? And so, um, at some point you, as you scale,

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it's the remote. Uh, function or the virtual function really starts playing a big factor in that,

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but, but that doesn't mean the PCPs. Like they have to have a great, let's say Tommy is the care manager,

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he's supporting three practices. He, he really needs to have a great relationship with each of those PCPs,

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right? And, and, and they have to know that, hey, here's my trigger if,

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if this person scores, let's say it's a 5 over on the PHQ 9s and they score 5 or higher,

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that I know that this patient. fits well within the collaborative care. Here's what I'm going to say.

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Here's how I introduce them, um, and then I know as a PCP they have to, the PCP has to be confident in the services that are being

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provided. So, you know, with, with the collaborative care model, how, how it functions is that all the time spent,

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this is the financial sustainability for it, right? I think we said 2016 is when CMS implemented the Uh,

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the reimbursement codes for collaborative care. There's 3 reimbursement codes and

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And so what how it is, it's, it's a charge that is dropped once a month. So the time is um added up between the times

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the care manager, how much time the care managers spent with the patient, and how much time the psychiatric consultant is is spent with the patient.

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Um, and that's how you create the the sustainability because that time is added up and it charges drop once a month,

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but The PCPs have to be confident in the services that are being provided to hand the patient,

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right? Um, and then, and then you really create uh this well-oiled machine

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to support those mild and moderate patients that come in that are struggling from a mental health issue,

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right? And so instead of just putting them onto a, a specialist waitlist. Um, and,

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and you really as a PCP you don't have another touch point until they either get sick or come back for annual physical.

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First, you know, you're going to get on from a PCP standpoint, you will get regular updates.

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About, let's say I'm the patient. Thomas is the patient, you're going to get regular updates about Thomas on his progression that,

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you know, you've just prescribed him some kind of antidepressant, you're gonna to get regular updates from the psychiatric consultant and the care manager on

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Thomas's progression. And, and from a provider standpoint, um,

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that's a big jump from just kind of referring out and um and hoping that Thomas gets the

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help he needs and, and I'll see him in 6 months or a year, right?

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So one of the things that I mean, and you, and you kind of hinted at it earlier that's really,

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really

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really top of mind for me is that system, that model seems to uh really require a lot of trust between the PCP

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and the case manager. What, what's your thought on that, that level of trust and collaboration there?

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Well, I, and I think there, there is, there is a certain level of trust with that, and I think that's why it's so vital to have that,

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um,

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That

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that relationship that is built between the care manager and the PCP, um,

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you know, if, uh, and so, you know, that, that it's vital, right? The trust is vital.

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Um, the trust is vital, the, the, the care manager has to go in knowing that, that I'm really gonna have to get truly

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embedded in part of this team. And communicate, communicate, communicate.

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And now, now I, I say that with an asterisk because PCP is the last thing you want,

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uh, PCPs don't want to have to send often don't want to have to get more messages.

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They're getting patient messages, uh, order messages.

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I mean they're getting messages constantly, right? Again, going back to we're asking PCPs to do it all.

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The care manager has to go in with the idea and understanding that each PCP is going to have a different desire of

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communication, a different channel of communications. Some might, you know, want us, uh,

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some kind of EHR private message. Some might just want a note, so you,

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you're gonna have to, they're going to have to be very strategic in asking the individual provider,

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how's the best way for me to communicate with you when I have a And, and it could be just put a note in the chart and you know,

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so, but, but, but that's part of that is building that trust, right? You're the care managers showing the PCP I'm truly here to help

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support you and your patients like that, that's what my goal is and, and,

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um, and considering avenues for communication is vital. Thank you.

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And so on that note, uh, you know, the challenges of communication,

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what are other challenges and barriers that you've seen that prevent a collaborative care model from uh emerging in a practice?

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Besides, OK, the system, you know, the executives, they're bought in, they're gonna try their best to make this work.

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What stopped it from or it is a potential stopping point, uh, and barrier for this model being implemented in a practice?

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Well,

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Unfortunately, within our, our, um,

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The healthcare system we live in, it has to be financially sustainable and, and that is always a question when it comes to

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um this kind of model, right? I mean, it's been, it's almost 2026, so it's almost been 10 years since the codes have been created where

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you can bill,

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um, and so if you don't have high engagement from the patients,

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you aren't able to bill, right? And so That is really a big stopping point.

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So the, the key to a successful collaborative care model is engagement,

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engagement, engagement, right? And, and really getting in there and, and so that,

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that starts with the PCP introducing it, then it goes to the care manager. If the care manager takes 7 days,

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10 days to reach out to the patient. The opportunity might have already been, is might be already gone,

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like, you know, there, there has to be a very structured standpoint of hey, I,

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I'm going to introduce you as a PCP. I have to introduce you to Tommy. Um, he's our care manager.

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He's gonna reach out to you within 48 hours, right? So I mean setting that expectation of we need,

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it's, it's almost like front loading that communication. Um, and, and I think that's probably the,

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the most vital, right? I mean, what we're talking about downstream is the financial impact and keeping it sustainable,

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but at the very front end, it's the engagement, which starts with the relationship from the care manager and the PCP,

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right? So, um.

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Now, another starting point would be, um, of course, the registry, if you know how effective is your registry when you're tracking

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your panel on the patient population, how, how are people getting well,

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how effective your one on ones with the psychiatric as a care manager, how effective are your one on ones with the psychiatric consultant,

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right? If you have a panel of 50 and 10 aren't improving. Then you're going to want to flag those on

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your registry, right, and say when I meet with that psychiatric consultant, we need to game plan and strategize these 10 patients.

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Are they disengaged? Are they safety risk? Do we, do we need to just refer them to a specialist?

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Is this not really the level of care that they need? So Um, I think that throughput,

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because what ends up happening if it's effective throughput is that that builds more,

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more trust with the PCPs which who will then in turn refer more, be more confident in referring patients into the model.

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Understood. So, and I think Thomas, this is a very good teaser to the next part where we're going to be starting to talk about our impacts and outcomes and

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financial stability and things like that because, OK, let's say This model costs a little bit more than just a regular PCP

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visit upfront, but man, if we're keeping people from going inpatient to the hospital,

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well then the cost per, you know, per patient and the patient's life is positively impacted.

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The whole system's benefiting. So I think that's, uh, this is a good stopping place for us to really,

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really think about how we measure our impacts and outcomes and how to make this financially sustainable and how this all works.

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Numerically. So again, thank you, Thomas. Thank you everybody for listening and join us again for part 3 next week.

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Thank you for joining us. Be sure to keep an eye out for episode 3 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 show 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, the podcast that delivers evidence-based education for physicians and healthcare

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providers on the go.