Collaborative Care Conference Spotlights Change Management
Thought leaders at APA’s Collaborative Care Model (CoCM) Residency Training Education Conference offered guidance on how residents can advocate for CoCM.
Collaborative care has been shown time and again to improve outcomes in patients who have a mental illness. The challenge is to find ways to advocate for collaborative care and implement the institutional changes necessary to provide it. APA’s Collaborative Care Model (CoCM) Residency Training Education Conference in June brought together experts from around the country to educate residents on CoCM, provide tips for developing CoCM plans, and offer guidance on how residents can get buy-in from decision makers.
In her first presentation, Anna Ratzliff, M.D., Ph.D., co-director of the AIMS Center at the University of Washington, director of the UW Psychiatry Resident Training Program, and director of the UW Integrated Care Training Program for residents and fellows, provided an overview of CoCM: “The collaborative care model is a specific model of care that has core components, where a behavioral health care manager is embedded in a practice [to provide] consultations and evidence-based behavioral interventions.”
A vital step in producing change is to form a coalition of interested stakeholders, said Anna Ratzliff, M.D., Ph.D.
Terri D’Arrigo
Ratzliff added that CoCM achieves the following aims:
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Increased access to mental health care
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Improved clinical outcomes
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Reduced total cost of care
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Enhanced satisfaction and productivity among health professionals
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Increased patient satisfaction
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Reduced health disparities and stigma
“More than 90 randomized controlled trials have shown collaborative care to be more effective than usual care,” Ratzliff said.
Advocating for Change
In a second presentation, Ratzliff discussed ways for residents to get involved in collaborative care. “Most of us work at the local level, where there is a lot of opportunity—a home practice, in a group practice or clinic, in a health care system, or in an academic institution,” she said.
Ratzliff added that although care settings differ, launching CoCM will require buy-in and support from decision makers. “It’s important to think of advocacy as leading change management. You have to get people excited about changing things, which can be hard,” she said. “In some ways, medicine is behind business in operationalizing change management.”
Touching on principles outlined in the influential business management book “Leading Change” by John P. Kotter, Ratzliff discussed steps for change management as they might apply to advocating for and implementing CoCM. The first step is to create urgency and define value.
“What are the problems you are trying to solve with collaborative care?” Ratzliff said. “For example, it could be building health equity to reduce health disparities and stigma.”
The second step is to form a coalition of interested parties who have the power to produce change. “Do you need to take [your case] to leadership or to clinicians?” Ratzliff said. “Who has been effective at making change before? Who would be the early adopters?”
The third step is to create a vision. “You need a process that provides focus and builds a shared understanding of common purpose,” she said. “Then you need one or two people who will lead with input from a broad range of people in your coalition.”
From there, the fourth step is to communicate the vision to those whose buy-in is necessary to implement change and those who will be affected by the change. “Do different people need to hear [about the change] in different ways?” Ratzliff said. “Some people might be data people, others might be story people. Use all forms of communication possible.”
Planning and Billing
David Oslin, M.D., a professor of psychiatry at the University of Pennsylvania, spoke of the importance of developing a plan that is readily communicated to stakeholders. He said that behavioral health professionals should consider the following elements when designing a plan:
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Which patients will receive care though the model
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Staffing, including supervision, psychiatrist time, and training
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Flow in the electronic medical record
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Measurements of success
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Which people at the institution are allies and which people need to be won over
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Selling points
Sulamita Camargo, the senior director of finance and health systems integration at Meadows Mental Health Policy Institute, offered pointers on how to be successful when billing for CoCM services. “First, set patient responsibility,” she said. “The primary care provider must obtain consent, inform the patient that cost sharing applies, and document this in the patient chart.”
Camargo explained that there are myriad reasons why CoCM billing codes are not paid, such as patient cost sharing, gaps in episodes of care, issues with prior authorization, and claims being forwarded to the wrong place.
Gathering Support in Government
Kristin Kroeger, APA’s chief of advocacy, policy, and practice advancement, discussed APA’s efforts to create a collaborative care movement, including advocacy work in support of the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act, which would enhance Medicare payment rates for behavioral health intervention codes to help with the startup costs of implementing CoCM.
Kroeger urged attendees to reach out to their elected officials to encourage their support for the COMPLETE Care Act and other legislation that would support CoCM and integrated care. “Get involved in advocacy, because the more [legislators] hear from you, the more they become aware” of what psychiatrists and other mental health professionals need, she said. ■
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Published online: 27 August 2024
Published in print: September 1, 2024 – September 30, 2024
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