APA Backs Collaborative-Care Model Being Considered for Medicare

In a letter to Donald Berwick, M.D., administrator of the Centers for Medicare and Medicaid Services (CMS), APA Medical Director James H. Scully Jr., M.D., endorsed a proposal by Jurgen Unutzer, M.D., on "Collaborative Care for Primary/Co-Morbid Mental Disorders" to be included in demonstration projects under Medicare and Medicaid.

"Collaborative care is a recognized best practice for the treatment of depression and other common mental/behavioral disorders that are seen in primary care, and the available evidence for the value of the model presented by Dr. Unutzer exceeds the evidence base for many universally accepted health care best practices," Scully wrote in the September 21 letter.

"More than 20 million Medicare and Medicaid beneficiaries have depression and/or other common behavioral health problems—many of these are people with chronic medical illnesses, such as diabetes and heart disease," he added. "Collaborative care for depression, in which a consulting psychiatrist and a care manager systematically support a primary care provider in managing a patient's depression, has been shown to double the effectiveness of care, improve overall patient functioning, and reduce total health care costs relative to current practice.

"Unfortunately, the Medicare and Medicaid programs currently do not support key components of collaborative care... and this is a major barrier to more widespread adoption and implementation of this evidence-based practice.... APA hopes that CMS will rapidly implement Dr. Unutzer's proposed program, since it addresses the unmet behavioral health needs for a large percentage of the U.S. population. It can improve patient experience, treatment quality, and outcomes of care while reducing overall health care costs."