Collaborative Care Model Series - Episode 4

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Transcript

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You're listening to Vital Signs, a podcast for Sentera providers. Welcome to episode four 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 and welcome back to Vital Signs, a podcast for Sentara providers.

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I'm Tommy Bateman, your host today, and with us we're. Back Thomas Lincoln, Director of Behavioral Health with Sentara.

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Uh, we have been talking about the collaborative care model, and we've gone from part one where we introduced it to we talked about

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what it takes to make one work. Then we talked about what is, what, what the effects of the collaborative care model.

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We talked about numbers and dollars and cents and some of the some of the cruder aspects of making things work,

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making the sausage, but now we wanted to talk about the future of the collaborative care model and what Uh,

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what we've been seeing, uh, at the street level. So Thomas, thank you for coming back.

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Uh,

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one, the next thing we wanted to talk about was kind of the future. What, what do we see,

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uh, you know, collaborative care model really, as you said, was developed, you know.

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Last decade even so in the healthcare world, that's yesterday. Uh, so things things that don't move,

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uh, uh, uh, and develop a whole new framework quite so fast. So we're seeing the beginning versions of it.

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Uh, we, we're seeing hope for the model growing. Where do you see it in the next 5 to 10 years?

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Yeah, yeah, so.

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You know, um, maybe the, the readers might be a little bit familiar with like the Institute of Healthcare Improvement.

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So, um, it's kind of an agency that really supports, uh, influences US federal policy development,

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um, but they, they, they developed this framework called the Triple Aim and envision a triangle,

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um, and it really was the focus on improving healthcare, right? So. Um, improving patient experience,

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uh, improving the health of, of population, so, um, and then reducing the cost,

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right? So it's, it's really trying to impact that. Uh, it was actually later kind of expanded into like,

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uh, the quadruple aim added another kind of corner doesn't make it a triangle anymore,

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but, um, improving the work, um, work life of, of healthcare,

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so like resiliency, burnout, that kind of stuff, right, um. And so

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You know what COCM initially does, it really addresses the psychiatric workforce shortage,

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um, the demand, the surge of healthcare, the payer push for measurement outcomes, um,

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and, and really the shift towards a value-based care, but what, what I would say,

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um, in the future would probably be, you know, right now it's really unevenly implemented,

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so.

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There, there's, um, you know, like we were saying, we, we labeled the barriers of what, what stops this model from being implemented.

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So in the, in the next decade, I would expect that this is really standard practice in primary care.

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I mean, this is, I think, I think, I think patients demand it often, you know, even that,

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that it's just demanded that this is a service that's supported that you can get within your PCP practice first getting a referral,

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waiting, you know. 3 months to see a patient. I mean, you and I know in this field like people die in 3 months suffering from mental

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illness. Like it's, that's to me, that's unacceptable, right? But um I think it's probably widespread.

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You mentioned it's not really just PCPs. It's probably, you'll see it in OB practices that, you know,

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I was really fortunate to have that kind of experience of rolling it out in multi-site OB practice,

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but

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Geriatrics, uh, specialty care clinics, I think it, it's, um, and,

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and not just adult, uh, primary care, so. Um, you know, the,

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of course, the digital component where you know I mentioned that we, a lot of people are still using just Excel spreadsheets to track,

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um, I think really the streamlining that that caseload tracking through the EHR systems will,

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um, will become kind of more and more

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I, I can't really leave off AI, right? I mean, machine learning, AI,

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you know, any kind of predictive model. I mean we see this everywhere these days. Um,

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probably I would say predicting kind of a risk of relapse, uh, poor response,

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flagging them earlier, right? So, you know, this is the care managers are responsible for flagging,

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hey, this is a disengaged patient or there's safety risk. Talk to the psych consultant with,

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um, so I, I would say that's probably um.

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will be much more embedded within um

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Within the EHR systems that they're using, you know, right now there's a big focus on depression and anxiety.

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I think there's probably a huge expansion of this. So we probably, we actually in Center see this with the chronic care management that's been rolled out,

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um, you know, I think it, it probably ventures away from just depression and anxiety to encompassing more,

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um, SMI substance use disorders. I think it, um.

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You know, expands in it kind of that way

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and then um back to the back to the kind of payment.

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Um, payment consideration, you know, we have made big strides. I mean,

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I, I, I don't have the numbers, but I guarantee that the payment has increased since 2016 when it was the CPT codes,

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yeah, right. So, so I, I would say that that probably improves as well. I think there's probably that they start moving more towards um

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reimbursement for uh.

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For the metrics, so improvement outcomes, higher, higher payment, you know, value-based contracts,

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um, implement everything like the ACOs and so, um, yeah, so,

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and then, you know, we

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workforce, I mean, you know, we'll, we'll, like I said, we'll never have uh enough psychiatrists and never have

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enough mental health providers in their community to support the need in the community. We have to be very intentional on how to Um,

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be efficient in utilizing those services, right? And so this is really leveraging that,

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I think, you know, uh. Um, there's probably a lot,

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I would say a lot of new trainings more for PCP psychiatrist collaboration, you know, you see kind of e-consults kind of being implemented

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and rolling out where PCP can can consult a psychiatrist to just bounce ideas off and they can,

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you know, feedback. I think that, that over a decade that somehow improves immensely,

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right? I mean, again, we talked about how

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we asked so much from PCPs and

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You know, it's, I mean, it's, it's, it's, it's almost unrealistic the things we ask from PCPs to get accomplished,

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right? Um,

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and so saying to a PCP of, hey, if you just need help, reach out to the psychiatrist and you don't have to wait 30 minutes or an hour to

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get a response like that's not efficient at all for for a PCP like that's, I mean,

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they're seeing 2025 patients a day. That's going to screw up their their schedule immensely.

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So they just won't do that. I think the, the digital aspect of, of what we see in the environment now enables

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more on-demand support for the PCPs. I don't know what that looks like, but I think that's probably um moving in that direction and then,

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and then like, you know, we're sitting here having this conversation, it almost makes too much sense, right?

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The whole person approach to supporting wellness, um. And,

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and, you know, we're, we've we've, we've come a long way as a society in supporting whole person care,

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but we're, we're, we're nowhere close where we need to be. I mean, you know, I go to my PCP and,

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and um I'm not.

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I don't receive the care that I envision we can, right? And I,

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so, and I hope again, you know, like I mentioned earlier, like we have bril, I am surrounded by brilliant people every day at work

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that are in this field and, and I, I'm hopeful that in the next, you know, decade that we really come together in a meaningful

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way to, to produce, um. You know, this, this overarching,

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what we call health or wellness and it be physical and mental are just so intertwined in how we talk

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about that, right?

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Absolutely. And, and, and you mentioned you, you talked about the PCPs, you talked about the specialist,

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the psychiatrist, but you know, as a, as a licensed BH provider, uh, I I just see our field,

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uh, changing dramatically from the traditional, you know, in grad school, we learn how to be good outpatient counselors,

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you know, the person sitting across from us on the couch, and we have the, you know, tissues from for them to something,

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uh, something. Different than probably what the field initially imagined. Uh, so there's,

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there's a lot of opportunity for everybody in this to grow professionally while making an actual,

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you know, deep impact, um, a measurable impact

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on people's health. Yeah, I think, you know, you, you kind of nailed on it like for, for like for clinicians.

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Um, that are in the field, I think there's a huge opportunity to put on leadership hats,

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not, not, not, not saying leadership hats like in an organizational structure, which is true. They,

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they, you know, social workers, you know, LPC perfect leadership candidates, right? But I'm saying more of a leader within the care delivery

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team, right? So I mean, you know, they're bringing expertise into the, the situation.

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That the other care providers don't have. And when we start leveling out that viewpoint,

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which is, you know, we're that goes into a stigma normalizing mental health, all that, but,

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but I mean, you know, I, I, I love to see clinicians, um,

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you know, and especially in like a hospital setting, like really standing in and being exactly part of that care team.

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Like that, that's where we need to be, right? What they say is extremely valuable because

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I mean, I, this is my, this is Thomas's thoughts, like, you know, mental health,

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physical health, which, you know, I think you might have mentioned it, which one's impacting the most? Which one's impacting more,

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right? Is it the mental or physical? And, and I strongly feel that mental drives that physical illness,

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right? So, um, anyway, that's my tangent for the, for the day. Well, absolutely,

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and in fact there's a lot of not diagnosable behavior. such as overeating, smoking,

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things like that, that smoking is diagnosable as a as a nicotine dependence, but you know,

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that impact our physical health. There are behaviors that having a behavioral health individual, uh,

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professional working in would would directly impact the physical health. So yeah, actually, you know, message received when it comes to that,

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but we only have a couple more minutes left. So why don't you tell us a story of a collabor care model in action it working.

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Yeah, yeah.

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So, um, I, I've worked in behavioral help my entire career, psychiatry, substance abuse in paycheck,

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um.

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Uh, except, except for, um, the week COVID hit, I went to my leaders in my role and said,

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hey, I want to be, I wasn't in a frontline team member role. I, and I was like, where's somewhere I can get down in the trenches?

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They there was an opening for an OB practice, a multi-site OB practice in rural North Carolina.

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So, um, jumped in, um, you know, rural. People,

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a lot of women use their OB as their PCP, you know, that, that, so, um,

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there was a huge need for mental health support within these practices. So we strategize what,

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what, what, how can we support it. We actually applied for a grant through the Duke Endowments,

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an organization down in Charlotte, North Carolina that gives out, you know, specific grants,

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uh, multi-year grants to stand-up programs that support the community, but we received a grant,

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a multi-year grant to hire a care manager. Um, to support these clinics.

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So, um, we, again, I was in a health system that didn't have a payer attached to

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it, so there were barriers financially. To create a sustainable model. So we applied for the grant,

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which they were super supportive of. We got a grant, we implemented this care manager and so we did it where,

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um, regardless of the PHQ 9 scores that, you know, for OB women,

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for, for women that were pregnant, we had a warm handoff at the 20-week um appointment.

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So, you know, when they're first getting their first ultrasound. Um, the,

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uh, tech would introduce him to our care manager that was on site, um, and

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And also though, if they were just having annual physical, so that, you know, if they're having just a gynecological appointment,

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they would, that we would do the PHQ 9 scores across the board, but they would trigger if it was over 5 to go to the care manager and enroll

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in this program. And so what we found out after about a year and a half is that financially we,

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we were using a psychiatrist that were, um, the health system I worked for had a, had a pretty robust uh.

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Psych services, outpatient services, inpatient services. We just tapped into a psychiatrist that was interested in supporting the care

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manager in this model, um, and, and we build under the,

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the OB so they were managing the care we build under the OB practice, you know, right, so the,

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the PCPs or the OB are the ones who dropped the charge. They don't have to, but that's how it was structured.

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After a year and a half, it was sustainable financially, right? Which, which even just from a care delivery side was sustainable.

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So like, you know, of course we saw the impacts to the moms, you know, the, the engagement,

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you, you know, for in a rural setting for OB you have moms that really don't get a lot of prenatal care,

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but now they have this support that they didn't have prior to. And they're being introduced,

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right? Most moms, most moms, um, I don't say most moms, a lot of them will come to their 20 week ultrasound,

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but they, they might miss those follow-up appointments and then come, they'll show up at the hospital when it's time to give birth.

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Well, now we have more engagement. So now the OBs when they're delivering the babies have more insight into what's been occurring over

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the past few months with this patient. Right? So it's a completely different level of care.

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So what it happened is that we had better outcomes, lower cesarean rates, um,

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you know, the, the, the quality of deliveries improved just because the engagement upstream.

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Improved. So, um, what was kind of cool too is we, we ended up hiring a licensed,

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uh, social worker. So, um, she could actually build outside of this model as well for like,

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you know, tell me what you're saying just outpatient psychotherapy. Well, what the community at the time.

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She felt needed and the obese all the providers agreed is that we could do postpartum depression groups in the evenings.

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We could do loss groups in the evenings for mothers that are lost, uh,

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lost kids. So there was a lot of impact. Now, um,

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And you know, thinking back, I it's probably one of the most proud I've been of working in healthcare of just truly,

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truly identifying an issue and trudging towards that, but you know.

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The model works if you get the buy-in, right? And, and, and you realize it's all about engagement,

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right? I mean, it, it is 100% about engagement and and trust building as you mentioned.

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Excell, Thomas, I, I do think this gives me a lot of hope for the future of healthcare, uh,

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you know, not only for, you know, patient outcomes and experience, uh, I see it,

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uh, you know, as an employee of a payer. I see it as a behavioral clinician. This model is,

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uh, something that would really, uh, Really tremendously impact the the the system as a whole.

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So I, I'm, you sold me. I want to be an advocate along with you on this one. So Thomas,

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thank you so much for showing up to these sessions and chatting with me about it and

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I uh I hope everybody listening has enjoyed.

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Series on the collaborative care model. I hope you'll have a wonderful day. Thanks, Tommy.

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Thank you for joining us. 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

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for physicians and healthcare providers on the g