Sustainable psychiatric expertise with primary care: How digitalizing your Collaborative Care Model can deliver cost returns and better outcomes

The prevalence of mental health issues is high, with one in three U.S. adults experiencing a mental illness during their lifetime.  However, although 60 percent of patients who obtain mental health treatment do so through their primary care provider (PCP), only 25 percent of individuals with behavioral health disorders who are treated within traditional primary care get better.

During Becker's Hospital Review's 13th Annual Meeting, in a roundtable sponsored by Amwell, two Amwell leaders — Matt McCormick, group vice president for behavioral health, and Carrie Nelson, MD, chief medical officer — led a discussion about how organizations that are providing mental and behavioral healthcare within primary care can leverage technology to improve collaboration, scale services, and improve patient outcomes.

Four key insights were:

1. The Collaborative Care Model (CoCM) is not producing the outcomes that were hoped for. The CoCM, which has been around for more than a decade, aims to address the difficulties of treating mental health issues in the primary care setting. However, because of this model's high staffing requirements in light of already scarce professionals — it requires a closely coordinated team comprising a primary care physician (PCP), a behavioral healthcare manager and a psychiatrist, alongside a patient registry — operationalizing the CoCM has been challenging.

2.  Technology can effectively fulfill the functions of the CoCM. Specifically, the Amwell Comprehensive Collaborative Care program, which uses technology to “stand in” for:

  • Registry function: SilverCloud by Amwell®, evidence-based digital behavioral health programs backed by two decades of clinical research, can be used to engage patients between PCP visits, and have a dashboard that can act as a patient registry.
  • Behavioral healthcare manager: Health systems can provide their own healthcare managers, or leverage a SilverCloud by Amwell coach.
  • Psychiatrists: Health systems can tap into Amwell Psychiatric Care, Amwell’s network of board-certified psychiatrists, who provide remote on-demand and schedule behavioral health consults to the PCP.

3.  Amwell's behavioral health solution can serve as a referral filter to scarce mental health professionals. While the solution is designed for patients with mild to moderate mental illness and not for patients with serious mental illness (SMI), such as bipolar disorder, it does play an important gatekeeping role in the SMI layer of the mental healthcare system by alleviating psychiatrists' workload. It accomplishes this by having participating PCPs consult with a psychiatrist first to determine whether a particular patient needs to be referred to psychiatry for a full evaluation before providing a referral. "It takes the burden off of psychiatrists, because you're not just referring patients [to them] all the time, but it's really referring the right patients," Dr. Nelson said.

4.  With Amwell's solution, providers can offer effective mental health services to patients. As a result of using SilverCloud by Amwell, mental health professionals have observed clinically significant improvement in patients 65 percent of the time. Meanwhile, 56 percent of patients are diagnosis-free after three months. "Within the CoCM, Amwell's digital technology can work as an adjunct to therapy, but also as a [standalone] registry," Mr. McCormick said. Also, this solution reduces the wait times for patients to receive therapy.

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