The Collaborative Care Model (CoCM) is an integrated care approach that helps primary care practitioners (PCPs) better manage people with mild and moderate psychiatric problems.
Using an evidence-based care team that includes a behavioral health care manager (BHCM) and a psychiatrist, the team meets for about an hour per week to review identified PCP patients who are not improving as expected, as measured by standardized instruments (eg, PHQ-9, GAD-7, AUDIT-C). The psychiatrist recommends changes in medication, therapy, tests, and other interventions, which the BHCM and PCP implement with patient education and input. Often there is a lot of education by the BHCM, explaining the importance of sleep schedules and hygiene, the right ways to take medication (eg, don’t take Wellbutrin before bed), managing medication side effects, etc.
Over 80 randomized clinical trials have demonstrated that this approach is feasible and/or effective for common conditions seen and managed by PCPs, including depression, anxiety disorders, and substance use disorders. One psychiatrist can effectively manage about 80 patients with only 1-2 hours per week. You make recommendations, the PCP decides how to use your advice, prescribes meds, orders labs, and handles the patients.
The initial challenge in getting started with CoCM is finding PCPs interested in using the model. And PCPs have trouble finding psychiatrists who want to do CoCM. The MPS aims to facilitate CoCM in Maryland by being a matchmaker between member psychiatrists and PCPs and others (I’ve also worked with OB/GYNs, cardiologists, and neurologists). This well-established treatment model is reimbursed by most payers, and the PCPs, in turn, pay the psychiatrists directly, often on an hourly or weekly/monthly basis.
As the first step in this initiative, MPS has added “Collaborative Care Model (CoCM) Consulting” to the areas of interest in the Find-a-Psychiatrist tool on the website. Members who want to be listed should email Heidi Bunes to be added, or log in to their member account to make the change. This list will make it easier for practices to find psychiatrists who are trained in and use this model (APA has free training for members, as well as for PCPs). It is also a new benefit of MPS membership.
Later, MPS plans to collaborate with MedChi to promote the availability of CoCM psychiatrists to MedChi members. We could also consider collaborating with MDDCSAM, as the model includes both psychiatrists and addiction medicine specialists as consultants. Once there are enough interested psychiatrists, MPS intends to form a CoCM Interest Group to enable members to work together to focus on workflow, quality, and outcomes. MPS could also consider seeking funding to become a statewide nonprofit resource for the broader medical community.
I am interested in working on growing this idea and am asking like-minded MPS members to contact Heidi if they want to be involved in this initiative. Also, please watch for the next MPS member survey and the MPS member data update form that will arrive in the coming months and indicate your interest there.
Steve Daviss, M.D. DFAPA FASAM