Collaborative care strategy is a starting point
The Grand Rapids-based Michigan Center for Clinical Systems Improvement intends to use a $1.7 million grant to fund a collaborative care management strategy whose mission is to improve the outcome of patients suffering from depression and related chronic diseases and shave health care costs.
Mi-CCSI’s grant is part of an $18 million initiative The Centers for Medicare and Medicaid Services is awarding to a national collaboration of partner organizations that includes Mi-CCSI. That three-year cooperative is part of a $1 billion CMS Health Care Innovation Challenge, which is funding the collaborative care management model for patients suffering from depression and the twofold blow of diabetes and/or cardiovascular disease.
The local health strategy is designed to deliver high-quality care, enhance the health care work force and lower costs through continuous improvement during its three-year cooperative agreement.
“The depression model has a long history of success elsewhere,” said Steve Williams, Mi-CCSI’s executive director. “It’s very clear it brings about better results with patients at a lower cost, although it’s a little unproven with the costs.
“Our sense is, if it gets these diseases well managed, then what we learn in these kinds of programs we can apply with other conditions and move the needle on health care quality and cost.”
Mi-CCSI is a collaborative improvement organization whose board consists of Advantage Health, Metro Health, Spectrum Health, Borgess Health in Kalamazoo and Lakeshore Health Network in Muskegon, as well as health insurers Blue Cross Blue Shield of Michigan, Blue Care Network and Priority Health, plus the West Michigan Provider Network and Physicians Organization of West Michigan.
The local collaborative health model will initially start with five primary care practices, then next year add nine more for an eventual total of 14 primary care practices.
Williams said Mi-CCSI’s cooperative agreement follows the lead of two other health collaborative approaches for depression treatment. One is the University of Washington’s IMPACT (Improving Mood: Promoting Access To Collaborative Treatment for Late Life Depression). IMPACT discovered clinical depression affects about 3 million older adults in the United Sates and is associated with 50 to 70 percent of higher health care expenses, mostly due to an increased use of medical services.
The second health collaborative is the Institute for Clinical Systems Improvement’s DIAMOND Initiative (Depression Improvement Across Minnesota Offering a New Direction) that concluded depression is one of the most common, costly and disabling medical conditions whose current care has barely changed since 1999. ICSI has helped more than 80 primary care clinics implement the collaborative care management model in Minnesota through its DIAMOND program.
Conversely, Mi-CCSI is in the midst of facilitating the implementation of the DIAMOND model via primary care practices in West Michigan, which involves enrolling patients this fall. Mi-CCSI’s grant is intended to expand and accelerate the work already underway, said Williams.
The goal is to voluntarily enroll an initial 1,000 patients by June 2013, said Dr. Paul Ponstein, medical director at Lakeshore Health Network, who will soon become executive medical director of the Physicians Organization of Michigan Accountable Care Organization.
“There’s a connection between depression and all chronic conditions, but these two (diabetes and cardiovascular disease) stood out because they were two that were studied at the University of Washington,” said Ponstein. “Although our thought is, ‘This is a starting point,’ we will expand to other chronic conditions if this initiative proves successful.”
Study results continually find that workers with depression have a higher rate of absenteeism. Moreover, depression is one of the costliest health issues for employers because of its high prevalence and co-morbidity with other conditions. It is estimated to cost U.S. employers $44 billion annually, according to The Journal of the American Medical Association.
Entitlement programs are impacted, as well. Roughly 30 percent of Medicare patients have diabetes and another 30 percent have coronary artery disease, and when depression is present — 15 percent of the time — health care costs are 65 percent higher, according to Dr. Leif Solberg, director for care improvement research, HealthPartners Research Foundation in Minnesota.
“There is a need to target this population because studies show that more than half of patients with depression also suffer from other chronic conditions,” said Williams.
“Care managers can sort through a patient’s history and really bring that to a physician in a collaborative model, rather than just being on a clinical treadmill where patients go back over and over again but the diabetes or cardiovascular disease doesn’t improve. There are a lot of barriers, and these models are designed to work through those barriers.”
Pine Rest Christian Mental Health Services will be added to the mix to work in tandem with improving patients’ mental and physical health, which is not always taken into consideration with health care trends, said Ponstein.
“We have medical care and we have behavioral health, and it’s kind of an abnormal gap or chasm between the two,” Ponstein said. “We want to close that. It makes no sense to have behavioral health not integrated with medical health. We’ve had a lot of conversations between Pine Rest, and we all agree we want to close that gap.”
Depression isn’t solely connected to diabetes and cardiovascular disorders, but they are conditions with a well-known track record of what causes them. Improving those conditions could eventually be applied to other diseases.
“There’s a lot known about diabetes and the care of cardiovascular disease, with a focus on high cholesterol,” said Williams. “When you throw those into the morbidity of depression with cardiovascular disease, it becomes a much more complicated problem, yet we know an awful lot of how diseases work and affect patients.
“These are (diseases) with a high prevalence, high correlation with each other,” added Williams.
Partners in the national collaborative include the Institute for Clinical Systems Improvement in Minnesota; Mayo Clinic Health System; Kaiser Permanente Colorado; Kaiser Permanente Southern California; Community Health Plan of Washington; Pittsburgh Regional Health Initiative; and Mount Auburn Cambridge Independent Practice Association in Massachusetts.
Other participating health care-related organizations include HealthPartners Research Foundation in Minnesota and the Advancing Integrated Mental Health Solutions Center at the University of Washington.