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The Great Debate

Posted By Benjamin Miller, Thursday, September 05, 2013


This is the third post in a series of "blasts from the past". These classic posts will highlight issues that are just too important to collect dust in the archives. The series will be off and on for the next several weeks. Enjoy!

(This piece was originally posted on September 21, 2012)

Changing 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” phenomenon.

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

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:

  • Clinical: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 deny.

  • 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.

  • Financial: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

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.

  • Second, 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 thinking.


AJ Jayabarathan

Ajantha Jayabarathan MD
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.

In ten 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.

Meanwhile, 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 unstoppable.


Eduardo Sanchez

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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10/13/2016 » 10/15/2016
CFHA 2016 Conference: "Celebrating the Many Faces and Places of Integration"