by Nicole Stelter, Ph.D, LMFT, and director of Behavioral Health for Blue Shield of California
Millions of people in California live with mental and behavioral health challenges, compounded by increasingly limited access to care.
Adults reporting symptoms of anxiety and depression is especially common today, impacting more than 31% of Californians. A recent study by Blue Shield of California and Harris Poll also found that 87% of Gen Z youth report that they are struggling with their mental health. Yet, nearly 28% of people diagnosed with anxiety or depression couldn’t access counseling or therapy. Even after referral, about one-fifth of adults in mental health treatment drop out before completing their recommended course of treatment. Barriers to care can be even more dire by state; in California, the supply of psychiatrists will be 41% less than what is needed to meet the demand for services. This has severe implications for patients and the healthcare ecosystem. Fortunately, adopting the right approach to care can help address both issues. The Collaborative Care model supports patients to get better faster — it's proven to work.
Introducing the Collaborative Care Model
Developed by the Advancing Integrated Mental Health Solutions (AIMS) Center at the University of Washington, Collaborative Care is a systematic approach to integrated behavioral health care based on the chronic care model that has the most substantial research evidence to date. Over 90 randomized controlled trials have shown Collaborative Care to be more effective than traditional, segmented care.
Collaborative Care centers care around the patient, meaning primary care and behavioral health providers collaborate using shared care plans to address patient goals. Together, they conduct ongoing caseload reviews using a shared registry, which allows the team to track patients' clinical outcome measures over time and flag patients who are not showing improvement. Each patient also has a dedicated behavioral health care manager who helps track and coordinate care and facilitates patient engagement.
Importantly, Collaborative Care leverages the established relationships that members have with their primary care physician (PCP), so that behavioral health care is integrated in those regular visits, without the member having to wait for an appointment with a psychiatrist. Patients with depression report twice as many health complaints to their PCP compared to those without depression, making them more likely to be in regular contact with their PCP. Furthermore, with this established relationship, mental health treatment dropout is the lowest for patients treated by their PCP.
Also of note, Collaborative Care differs from co-located care, which means primary care and behavioral health providers work separately under the same roof, not necessarily collaborating or creating a shared care plan between different providers and specialties.
Increasing Access through Collaborative Care: How It Works
At its core, Collaborative Care is a population health model that delivers value-based care focusing on patient experience and provider support. When implemented correctly, it hits on three key focus areas that help address and improve access to effective care:
- Navigation: Even with a sizable network, patients, particularly those struggling with mental health conditions paired with other existing conditions, have challenges finding a provider that accepts their insurance, is trained appropriately for their needs and is accepting new patients. With Collaborative Care, the behavioral health care manager helps find the appropriate level of care based on their work and assessments with the member. Should they refer out to a licensed professional, the behavioral health care manager will follow through on the referral and ensure a connection is made with a provider that is a good fit for the member. The behavioral health care manager will also continue tracking each member to ensure their needs are met and that the entire care team is informed of the shared goals and care plan.
- Equity and Inclusion: Even as mental health discussions become more prominent in the U.S., stigma around seeking and receiving care is still a significant barrier. Collaborative Care seamlessly integrates into primary care, pediatric, or the OB/GYN clinic where a member is already comfortable going and receiving care. Studies show that when behavioral health care is delivered in conjunction with primary care, there is less stigma and more normalization of the fact that behavioral health is health care. This approach also helps identify individuals who would not have sought care for their behavioral health needs and increases their understanding of and access to services. An example of this is a senior who may be reluctant to seek mental health care, but happens to have a strong relationship with a PCP. For vulnerable populations such as these, working with a physician one is already comfortable with breaks down a major barrier in this transition into receiving mental health treatment, perhaps for the first time. In fact, nearly 60% of patients who receive mental health treatment do so from their PCP.
- Cost: Cost can be a major detractor to seeking care, especially when patients have high deductible plans and have to pay out of pocket. Collaborative Care is designed to help the member receive the care they need at the right time and at a very minimal cost or no cost to the member. Additionally, specialty care and potential emergency department costs are mitigated by Collaborative Care’s early intervention and more successful patient adherence outcomes.
At Blue Shield, we are working to eliminate co-insurance for Collaborative Care services provided within our in-network medical groups. While a co-insurance cost depends on the member's plan, the fee is nominal compared to other services and care delivery.
Multifaceted Benefits of Collaborative Care
Collaborative Care can decrease care costs, enhance quality of care, and improve member engagement and retention. This is a multifaceted model that helps address widespread challenges within healthcare systems. Patients aren’t the only ones benefiting from Collaborative Care, there is also increased provider satisfaction. Primary care providers (and in some programs, pediatric and OB/GYN providers) receive added support and expert consultation for mild depression and anxiety medication management, are less burdened with panel management, and ultimately their concerns about where to direct members with mental health needs are reduced.
While the concepts of collaboration, integration and co-location are widely discussed in the industry, true implementation of the Collaborative Care model is few and far between. Here at Blue Shield, we are working to change that. Nearly 413,000 Blue Shield of California members now have access to Collaborative Care, and the number continues to grow. Another great thing about implementing Collaborative Care with new provider groups is that it benefits all patients at the medical practice — everyone will receive improved care, whether they are a Blue Shield of California member or not. Our goal is to implement Collaborative Care across all provider groups to ensure that every Californian has access to this patient-centered, evidenced-based model that improves outcomes.