Morris Hospital's Dr. Jennifer Thomas on the secret to happier physicians & more engaged mental health patients

Jennifer Thomas, MD, is a family medicine physician and director of integrated care at Morris (Ill.) Hospital.

She is overseeing the hospital's Collaborative Care pilot program, which aims to improve behavioral healthcare services by placing social workers and mental health professionals in primary care offices.

Here, Dr. Thomas outlines the challenges of addressing behavioral health needs in primary care, discusses the importance of integrated care, and shares initial results from Morris Hospital's pilot program.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What was the motivation behind implementing the Collaborative Care program?

Dr. Jennifer Thomas: I joined Morris Hospital right out of residency in 2010. As a family physician, I knew mental health was part of primary care, but I had no idea how many mental health issues I would be asked to address on a daily basis. Over and over, I'd be asked to help diagnose and treat patients' mental health concerns, and I found myself wishing I knew more about behavioral health issues. I also began to notice that it was not that easy to refer these patients to specialty services. We are not alone in our region in feeling the shortage of mental health providers in this country. Primary care providers are the "de facto" mental health provider in the U.S., with 70 percent of antidepressants in the U.S. prescribed by primary care physicians, not psychiatrists. And the difficulties in accessing mental healthcare are only more pronounced for our patients with Medicaid insurance.

In 2018, I decided I needed to "go back to school" a bit! I enrolled in a program through the University of California Davis called "Train New Trainers Primary Care Psychiatry Fellowship." This program was designed for clinicians, like me, who were already working in full-time medical practices but wanted additional training in mental health. The knowledge and mentorship I received through the fellowship experience truly transformed my practice. I feel more competent in my ability to diagnose and treat behavioral health conditions commonly seen in the primary care setting.

Q: How did you learn about the program, and what does it entail?

JT: Through the fellowship training, I learned about a model of delivering behavioral health services in the primary care setting called the Collaborative Care model. Developed at the University of Washington's Advancing Integrated Mental Health Solutions Center [in Seattle], the Collaborative Care model brings in two new teammates to the primary care provider's team: a behavioral healthcare manager and a consulting psychiatrist.

The team addresses mental health concerns in the primary care setting, rather than referring off-site for these types of services. The team tracks a defined patient population, tracked in a registry, to ensure that patients do not fall through the cracks. The care manager discusses patient cases and progress with a consulting psychiatrist on a weekly basis. The psychiatrist makes treatment recommendations, and the care manager relays these recommendations to the primary care provider and to the patient. The care manager also provides the patient with brief psychotherapy, with techniques such as behavioral activation and problem-solving therapy, proven to be effective in the primary care setting. 

Q: What results have you seen from the pilot so far?

JT: We have been fortunate enough to develop a collaborative relationship with the AIMS Center at the University of Washington. Through implementation coaching and support services, we launched our Collaborative Care pilot program at Morris Hospital in February 2019. We launched our program with a licensed clinical social worker as a care manager, who splits her time between two offices: the Gardner family medicine practice and the Morris OB-GYN practice. We have since expanded the program to our Minooka, Ill., practice site, with an additional care manager working with internal medicine and pediatric providers.

So far in the pilot, we've seen patients become more engaged in their treatment plans. By receiving these services in the familiar primary care setting, patients have been more likely to follow through on making appointments, and patients are more invested in the care plan. Patients have embraced this model, commenting that it helps decrease the stigma associated with mental health issues. The primary care providers have embraced CoCM, as well. By having another team member in the office who can help address mental health concerns, primary care physicians feel more supported in their work. With the expertise of a psychiatrist on the team, primary care physicians are more comfortable learning to manage medications that may have previously been outside their comfort zone.

Q: How do you see the program expanding? What is the program's ultimate goal?

JT: Eventually, we'd like to see Collaborative Care services available at all primary care sites. Collaborative Care is one model of delivering integrated care, where providers work together to address physical health alongside mental health, addressing whole-person needs. The largest barrier we have seen is financial sustainability. The literature proves CoCM is an effective and cost-saving model, but funding these programs has been a challenge. Many integrated care initiatives rely on grants and philanthropic support.

In Illinois, there has been a recent, exciting development in the world of integrated care. In August 2019, Gov. J.B. Pritzker signed into law a Senate bill mandating that private insurance companies, as well as Medicaid, reimburse for CoCM services. We feel this is a tremendous win for integrated care and will go a long way to help CoCM programs sustain the tremendous work they are doing in the community. We've just begun our integrated care journey at Morris Hospital, but we've already seen a wonderful impact in the lives of our patients. We are excited to see Collaborative Care continue to grow.

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