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Advancing the Evidence for Collaborative Care

Posted By Ben Miller, Saturday, September 5, 2009
Updated: Wednesday, June 1, 2011

The case for integrating mental health services into primary care has been made. We know that primary care, the largest platform for healthcare delivery in the United States, remains the de facto mental health system. There is evidence to support combining mental health and primary care services to more comprehensively address the construct of health (mental and physical), but when making a business/policy case for such integration there is less evidence for what works and what models or elements of models should be incorporated to reach the desired health outcomes.

A recent systematic review (Butler, et al., 2008) pointed out that it is often difficult to tease apart the success of integrating mental health into primary care from the attention that a specific disease is receiving. Of the 33 studies examined, 26 focused primarily on depression. If depression were the only mental health condition we treated in primary care, we may have more answers, but it is not as patients bring complexity co-mingled with co-morbidity.

To this end, the Collaborative Care Research Network (CCRN) was created to expand the evidentiary support for mental health in primary care and to enhance the understanding of what works using a practice-based research network (PBRN) structure. To date, 40 practices have enrolled. The team developed a position paper arguing for a collaborative care PBRN and sent it to the Agency for Healthcare Research and Quality (AHRQ), after which we were advised to immediately submit a grant application as they had certain dollars that needed to be spent this fiscal year. We were also advised to keep an eye on the AHRQ website if the President's stimulus package was approved as there would be initiatives of interest.

Dr. CJ Peeks reminds us of the famous Peter Drucker quote: "In business and elsewhere, nothing ever happens except when created by a monomaniac on a mission." And monomaniacs we (CCRN) are. Even so, we are systems folks who are observing what Harry Goolishian said was the first rule of working in systems--keep the conversation going; hence this communication and blog. For more information on the CCRN, please visit

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Comments on this post...

Randall Reitz says...
Posted Friday, July 8, 2011

I think we're just now getting organized around what it would take to make the financial case for integration. From what I've read and heard, I believe the only research that will truly make the case would be a very broad analysis that shows savings "downstream".

I think in a reformed insurance environment (i.e. medical home reimbursement) a case can be made that integrated behaviorists can pay their own way. I hope that pans out.

I really respect what you're doing with CCRN. It is exactly what is needed to make the case.
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Ben Miller says...
Posted Friday, July 8, 2011
Thanks, Randall. You raise a great point - I would say that with the financial case, we also should include the clinical and operational (simultaneously - thank you Dr. Peek). The only way to advance collaborative care comprehensively is through this approach. Here is more info on what we are thinking CLICK HERE
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Peter Y. Fifield says...
Posted Friday, July 8, 2011
Ben, your efforts at CCRN are outstanding. It appears that one of the reasons for pushback from many private facilities is related to the financial aspect. That being said, calculating downstream const effectiveness appears to be daunting yet obtainable. Also Through patient and provider surveys we can establish that integrated care makes for happier patients and providers. What really is difficult though is to qualify and quantify if patients are actually getting healthier. The sticky wicket becomes obvious when attempting to isolate confounding variables related to for example "did BHS interventions make a persons A1C's improve". This would be a difficult charge for any researcher. That being said, I think your repository of data related to this topic is exactly what we need for some sort of meta analysis to address such complex correlations in this field.
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