Posted By Benjamin Miller,
Friday, September 21, 2012
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healthcare requires an ability to gracefully navigate between competing
interests and ideologies. Depending on "where you sit,” what type of change you
want may be different than what your neighbor wants. Change is relative, and
aims, goals, and objectives are often dependent on who you are professionally
and who you work for. Integrating care, specifically behavioral health and
primary care, brings out some of the best and worst of this "where you sit”
To this end,
CFHA will host a presidential-style debate for the Friday plenary at our
October 4-6 conference in Austin. We will grapple with the question: "Will collaborative care be a mainstream healthcare model within a decade?" To get you excited for this event, our blog
today presents the opening statements of our 4 debaters. As the moderator for
the plenary session it will be my job to engage these leaders and hear all
sides of the argument. Who will win this debate? Whose side will come out on
top? That decision is up to you, dear reader.
Randall Reitz PhD is CFHA's Director of Social Media and the the Director of Behavioral Sciences at the St Mary's Family Medicine Residency in Grand Junction, CO.
Collaborative care is still a gangly,
pre-pubescent David amongst the Goliaths of healthcare. We lack the scale, strength, and resources of
the major industry players. That being
said we are on the precipice of something great. Within the next decade the clinical,
operational, and financial aspects of collaborative care converge to push our
model into the mainstream of healthcare:
We now have empirical evidence published in top scientific journals that
demonstrates the proven effectiveness of collaborative care in terms that even
the most hardened insurance executive or corrupt government official could not
- Operational: The simple reality is that we have
experienced exponential growth in the adoption of collaborative care operations
at all levels of the American healthcare system. We have already conquered the public sector
and are within a decade of conquering the entire system.
Our research and policy advocacy has already won the hearts and minds of
policy makers. The teeter-totter of
policy and payment is already reaching the tipping point at which the laws,
regulations, and reimbursement standards will align to insist on financially
sustaining collaborative care as a wholly necessary, fully-funded, and central
feature of American healthcare.
Paul Simmons MD is a
faculty physician at St. Mary’s Family Medicine Residency Program in Grand
Junction, Colorado. He enjoys Apple
products, black coffee, fountain pens and eponyms.
In this group of true believers, I have the honor of standing
boldly as the lone skeptic who has not yet drunk of the collaborative care
Kool-Aid. There are several reasons that
collaborative care will not, unlike flying cars, be mainstream by 2022.
- First, the collaborative care clan cites
supposedly supportive studies that are flawed, biased and not generalizable to
the real world. The evidence-based
emperor has no clothes.
collaborative care will not be able to overcome its own vagueness and
impassioned, but unfocused, hand-waving.
If advocates cannot clearly and rigorously define what they’re
advocating, passion fails to persuade.
- Third, the fevered dream of collaborative care will be exposed to the
harsh, bright light of financial and payment system realities.
Despite these hard truths, I can hardly hope
to persuade the diehards who have pledged their lives and fortunes to the cult
of collaboration. Disillusionment is
difficult, but we should always prefer reality to the pipe-dream of wishful
20 years of practice in
primary care, 10 years of
working on television and radio, 8 years of association with the Canadian
National working group on shared mental health care, 16 years of raising a
family while living in Nova Scotia, Canada, inform my opinions of how health
care is evolving in 2012.
Yes and No…
so states my reading of the tea leaves of time.
years’ time, if Obamacare is actualized in the United States of America,
integration of mental and physical health through collaborative, co-located
mental and physical health services will become the mainstream model of care.
If the injection of funds and faith into this model of care is thwarted by the
politics of 2012, the rate of uptake of this model will be slower and the
United States might well be left ten years behind as health care evolves
because of this model in the rest of the world.
in Canada, Australia, New Zealand and the United Kingdom, this model of care
has already seeded fertile health care fields and is growing in strength,
outcomes and diversity. Coupled with the parallel explosions of the information
age via the internet, virtual social networks via social media and electronic
management of health care it has steadily gained momentum …..and is now
Eduardo Sanchez MD is
Vice President and Chief Medical Officer, BlueCross/Blue Shield-Texas
|Opining as a health plan chief medical officer, I believe
that the health system will have evolved to a collaborative care model by
2022. The direct and indirect
medical costs associated with behavioral health, when it is not recognized and
not well managed, can no longer be ignored. |
Employers and health plans are beginning to appreciate that
better employee health status correlates with higher productivity and an upside
bottom line and that medical costs decrease and, more significantly, workplace
productivity improves when behavioral health is appropriately and
"collaboratively” managed. As a
result, employers (whether they are corporate America, small business owners,
government, and non-governmental organizations) and health plans across the
United States will join health care providers and patients to accelerate the
realization of a competent, considerate, culturally-relevant, compassionate,
collaborative health system.
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