http://www.cfha.net/forum_thread.php?t=55Recent posts in Benjamin Miller: Advancing the Evidence for Collaborative Care http://www.cfha.net/forum_thread.php?t=55#post81p classMsoNormalBennbspyour efforts at CCRN are outstanding.nbsp Itappears that one of the reasons for pushback from many private facilities isrelated to the financial aspect.nbsp That being said calculating downstreamconst effectiveness appears to be daunting yet obtainable.nbsp Also Throughpatient and provider surveys we can establish that integrated care makes forhappier patients and providers.nbsp What really is difficult though is toqualify and quantify if patients are actually getting healthier. The stickywicket becomes obvious when attempting to isolate confounding variables relatedto for example did BHS interventions make a persons A1Csimprove.nbsp This would be a difficultcharge for any researcher.nbsp That being said I think your repository ofdata related to this topic is exactly what we need for some sort of metaanalysis to address such complex correlations in this field.nbspphttp://www.cfha.net/forum_thread.php?t=55#post72pThanks Randall. You raise a great point - I would say that with thefinancial case we also should include the clinical and operationalsimultaneously - thank you Dr. Peek. The only way to advancecollaborative care comprehensively is through this approach. Here ismore info on what we are thinking a hrefhttpbit.lyxgkjB CLICK HEREaphttp://www.cfha.net/forum_thread.php?t=55#post69pBenppnbspppI think were just now getting organized around what it would take to make the financial case for integration.nbsp From what Ive read and heard I believe the only research that will truly make the case would be a very broad analysis that shows savings downstream.nbspppnbspppI 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.ppnbspppI really respect what youre doing with CCRN.nbsp It is exactly what is needed to make the case.phttp://www.cfha.net/forum_thread.php?t=55#post68pThe case for integrating mental healthservices into primary care has been made. We know that primary care thelargest platform for healthcare delivery in the United States remains the defacto mental health system. There is evidence to support combining mentalhealth and primary care services to more comprehensively address the constructof health mental and physical but when making a businesspolicy case forsuch integration there is less evidence for what works and what models orelements of models should be incorporated to reach the desired health outcomes.ppnbspppA recent systematic review Butler et al. 2008 pointed out that it is oftendifficult to tease apart the success of integrating mental health into primarycare from the attention that a specific disease is receiving. Of the 33 studiesexamined 26 focused primarily on depression. If depression were the onlymental health condition we treated in primary care we may have more answersbut it is not as patients bring complexity co-mingled with co-morbidity.pp classMsoNormalnbsppp classMsoNormalTo this end the Collaborative Care Research NetworkCCRN was created to expand the evidentiary support for mental health inprimary care and to enhance the understanding of what works using apractice-based research network PBRN structure. To date 40 practices haveenrolled. The team developed a position paper arguing for a collaborative carePBRN and sent it to the Agency for Healthcare Research and Quality AHRQafter which we were advised to immediately submit a grant application as theyhad certain dollars that needed to be spent this fiscal year. We were alsoadvised to keep an eye on the AHRQ website if the Presidents stimulus packagewas approved as there would be initiatives of interest.pp classMsoNormalnbsppp classMsoNormalDr. CJ Peeks reminds us of the famous Peter Druckerquote In business and elsewhere nothing ever happens except whencreated by a monomaniac on a mission. And monomaniacs we CCRN are. Evenso we are systems folks who are observing what Harry Goolishian said was thefirst rule of working in systems--keep the conversation going hence thiscommunication and blog. For more information on the CCRN please visit a hrefwww.aafp.orgnrnccrnwww.aafp.orgnrnccrnapp classMsoNormalnbsppp classMsoNormalnbsppp classMsoNormalFrom the financial perspective what researchquestions are most pressing for the collaborative care movementp