Integrated Care Refresh, Part 1: Integration of Behavioral Health Into Primary Care
This Editor’s Choice collection was published online in December 2021 and refreshes the original January 2019 collection on integrated care. To review all collections, please visit the Editor’s Choice section of ps.psychiatryonline.org.
Since publication of the first Editor’s Choice Collection on Integrated Care in 2019, the literature has continued to expand, reflecting a growing interest in and implementation of models to improve high-quality health care and access to it. We refresh this integrated care collection in two parts, the first focusing on integrated behavioral health care, and more specifically the collaborative care model, and the second highlighting innovations in integrated care.
Due to long-standing shortages of specialty mental health providers and deep-seated stigma surrounding mental illness, most behavioral health treatment in the United States has been delivered in the primary medical setting for decades. Usual behavioral health treatment in primary care, however, is challenged by limited resources, competing priorities, short visits, and lack of access to specialty treatment when indicated. The collaborative care model (CoCM) offers a solution through population health principles, technology, and systematic teamwork between the primary medical provider, a specially trained care manager, and a designated psychiatric consultant. CoCM is extensively evidence based, with more than 90 randomized controlled trials demonstrating its efficacy across a variety of populations and treatment settings. Implementation of CoCM also carries with it an opportunity to reduce inequities in behavioral health care by reducing stigma, improving access to care, and monitoring outcomes at the population level so that services can be tailored to address racial, ethnic, linguistic, and socioeconomic disparities.
This collection offers some of the latest research on CoCM that moves along the research-to-practice continuum from clinical trials to implementation, quality improvement, and financial sustainability. Some highlights include strategies to optimize key components of CoCM (e.g., the case review), a longitudinal evaluation of CoCM implementation, and guidance on how to use the novel CoCM billing codes to make the program financially sustainable.
Implementation
The Learning Curve After Implementation of Collaborative Care in a State Mental Health Integration Program
Carlo AD, Jeng PJ, Bao Y, et al.
Psychiatr Serv 2019; 70:139–142
https://doi.org/10.1176/appi.ps.201800249
Implementing the Collaborative Chronic Care Model in Mental Health Clinics: Achieving and Sustaining Clinical Effects
Bauer MS, Stolzmann K, Miller CJ, et al.
Psychiatr Serv 2021; 72:586–589
https://doi.org/10.1176/appi.ps.202000117
Designing an Academic-Community Telepsychiatry Partnership to Provide Inpatient and Outpatient Services in a Critical Access Hospital
Kimmel RJ, Iles-Shih MD, Ratzliff A, et al.
Psychiatr Serv 2019; 70:744–746
https://doi.org/10.1176/appi.ps.201800587
Impact of the COVID-19 Pandemic on Primary Care–Mental Health Integration Services in the VA Health System
Cornwell BL, Szymanski BR, McCarthy JF
Psychiatr Serv 2021; 72:972–973
https://doi.org/10.1176/appi.ps.202000607
Structural Components of Integrated Behavioral Health Care: A Comparison of National Programs
Goldman ML, Scharf DM, Brown JD, et al.
Online in Advance, Sept 9, 2021
https://doi.org/10.1176/appi.ps.201900623
Integrating Behavioral Health and Serious Illness Care in a Post–COVID-19 Environment
Shalev D, Spaeth-Rublee B, Cheung S, et al.
Psychiatr Serv 2021; 72:1467–1470
https://doi.org/10.1176/appi.ps.202000903
Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program
Miller ES, Grobman WA, Ciolino JD, et al.
Psychiatr Serv 2021; 72:1268–1275
https://doi.org/10.1176/appi.ps.202000563
Assessing the Impact of Different Depression Treatment Success Metrics on Organizational Performance
Carlo AD, Chan G, Arao RF, et al.
Psychiatr Serv 2021; 72:830–834
https://doi.org/10.1176/appi.ps.202000364
Quality improvement
How a Health Center Eliminated the Waiting List for Psychiatric Services
Kinnan S, Emerson MR, Kern J, et al.
Psychiatr Serv 2019; 70:1176–1179
https://doi.org/10.1176/appi.ps.201900222
Best Practices for Systematic Case Review in Collaborative Care
Bauer AM, Williams MD, Ratzliff A, et al.
Psychiatr Serv 2019; 70:1064–1067
https://doi.org/10.1176/appi.ps.201900085
Recommendations for Integrated Systems and Services for People With Co-occurring Mental Health and Substance Use Conditions
Minkoff K, Covell NH
Online in Advance, Oct 13, 2021
https://doi.org/10.1176/appi.ps.202000839
A Continuum-Based Framework as a Practice Assessment Tool for Integration of General Health in Behavioral Health Care
Smali E, Talley RM, Goldman ML, et al.
Online in Advance, Sept 24, 2021
https://doi.org/10.1176/appi.ps.202000708
Financial sustainability
Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare
Marcotte LM, Reddy A, Zhou L, et al.
Psychiatr Serv 2021; 72:822–825
https://doi.org/10.1176/appi.ps.202000265
Sustaining the Collaborative Care Model (CoCM): Billing Newly Available CoCM CPT Codes in an Academic Primary Care System
Carlo AD, Drake L, Ratzliff ADH, et al.
Psychiatr Serv 2020; 71:972–974
https://doi.org/10.1176/appi.ps.201900581
Clinical trials
Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan
Kilbourne AM, Prenovost KM, Liebrecht C, et al.
Psychiatr Serv 2019; 70:219–224
