Population-based implementation of behavioral health detection and treatment into primary care: early data from New York state

Deborah J. Bowen,Danielle Gadbois,Erin LePoire,Ashley Heald,Amy Jones,Jay Carruthers,Joan Russo

doi:10.1186/s12913-021-06892-5

Abstract

BackgroundThe Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation—the New York State Collaborative Care Medicaid Program.Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model’s five steps from 2014 to 2019.MethodsWe used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims.ResultsA total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples.ConclusionsOffering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.

Highlights

The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings
Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care
Research has shown that the Collaborative Care Model is an effective way to treat depression and anxiety within primary care, real-world implementation continues to be a challenge

Summary

Introduction

The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. CoCM includes measurement-based treatment to target, population-based perspective, collaboration among clinicians, provision of evidence-based treatments for behavioral health issues, and accountability for patient improvement [1, 2]. CoCM is a team-based approach to treating common behavioral health conditions in a primary care setting. The members of the CoCM team include: the patient, a primary care provider (PCP), a behavioral health care manager (BHCM), and a psychiatric consultant [5]. The behavioral health care manager is embedded in the primary care clinic and provides ongoing care coordination and collaboration with the team, including brief, evidence-based behavioral interventions to the patient, as well as routine symptom monitoring and treatment geared toward a measurable target/goal [6]. The BHCM and psychiatric consultant use the registry to aid in clinical decision-making, proactively adjusting treatments that are not working as expected, and ensuring that no patients fall through the cracks

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