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I'm an Optomist

Posted By Gene "Rusty" Kallenberg, Wednesday, September 16, 2009
Updated: Thursday, June 9, 2011

It seems that I have been caught up in a totally new life of late. I have been hijacked by the Collaborative Care Movement! I have actually been a fan and practitioner of this movement for the past 10 years or more. But for the last few months the ride has become exponential. I have been a participant in the following activities that are part of this new accelerated movement to integrate mental/behavioral health into Primary Care:

1 – Planning the Feb, 2009 Annual Meeting of the Association of Departments of Family Medicine – during which a major plenary was devoted to incorporating mental health care into the Patient-Centered Medical Home with a great Canadian faculty, Nick Kates, who related his 14 year experience of embedding psychiatrists in general practice offices in Ontario.

2 – Co-planning the Oct, 2009 Annual Meeting of the Collaborative Family Healthcare Association (CFHA) – which is wholly devoted to integrating mental/behavioral health into primary care.

3 – The above CFHA activity has also involved helping to organize the associated Statewide Summit on Integrating Primary Care and Mental Health/Substance Use Services for the State of California. There will likely be 60+ participants in this statewide Summit.

4 – In order to understand the content of the above Summit I became an advisory board participant to the Integration Policy Initiative – a collaborative effort of the California Institute for Mental Health, the California Primary Care Association and the Integrated Behavioral Health Project funded by The California Endowment. During this tutelage I learned so far is that there are over 50 pilot programs in collaborative care going on in California alone!

5 – At the 2008 CFHA meeting in Denver, I participated in early discussions about trying to establish the Collaborative Care Research Network (CCRN) – the brainchild of Rodger Kessler, Ben Miller and others – which will be used to assess the current state of the practice of collaborative care nationally and will be the vehicle by which the movement will generate the evidence for the benefits of collaborative care.

6 – The CCRN discussions ended up allowing me to – in a small way - participate in the planning for an AHRQ supported meeting to help flesh out and launch the CCRN scheduled for October.

7 – As a follow on to the ADFM meeting – and with much effort of key leaders in the US collaborative care movement – there has been a new interest in MH/BH + PC integration on the part of the Patient-Centered Primary Care Collaborative (PCPCC), which is the driving organization for the new emphasis on the Patient-Centered Medical Home in the health care reform effort. The PCPCC has led a series of 10+ national phone calls that have had as many as 40+ participants from as far away as England. This group of experts has greatly increased the PCPCC’s knowledge base and awareness of the importance of integrating MH/BH and Substance Use into the "whole person” fabric of the PCMH. This effort may ultimately have an impact on the NCQA designation of the critical elements needed for a PCMH.

Now, I am relating these personal experiences not to blow any horns - as my participation has been more of a student and learner than as a major conceptualizer of the future. But rather to indicate the veritable tsunami of effort, attention, participation, and beginning-growing influence on public policy that these efforts and others like them are having on health care dicsussions. The upcoming California Summit will be the 5th one in as many years in association with the CFHA Annual Meeting - Washington, Rhode Island, West Virginia and Colorado being the other four. The PCPCC and NCQA are certainly national organizations. And while mental or behavioral health does not feature prominently in the bills before Congress – the practice community who will carry out health care under the new policies is getting the message.

And in parallel with this very rewarding exposure to both state and national efforts, I have tried to bring home to our own local clinical setting what I see as the increasingly clear pathways to the future of collaborative care. These involve not only increasing the sophistication of our models of practice but also the new emphases on population management of mental/behavioral/substance issues in our patients and the practice-based research efforts that will serve to continuously improve the care we deliver and the outcomes we all seek. These efforts exactly parallel those we are now seeing applied to primary care and medicine in general, hence, we are in good conceptual company!

So I am optimistic about the futures – the future of collaborative care, the future of American medicine and the future of the health and wellbeing of our patients, clients, their families and communities…of our society. Life is getting ever more complex and stressful. If we can put the mind and the body back together again – we will be up for the challenge.

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