How the Collaborative Care Model Is Changing Psychiatry Practice

Healthcare is constantly evolving, and after three years of research, experts at The American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM) identified an integrative care model that is cost-effective, provides excellent health outcomes, and delivers provider and patient satisfaction. This evidence-based model is also helping expand the reach of psychiatrists to more patients.

The Collaborative Care Model is a system of delivering mental health services to patients in primary care and other medical settings, which allows patients to access services through an integrative, team-based approach. The care team is led by a primary care provider and includes behavioral health care managers, psychiatrists, and other mental health professionals who are empowered to work at the top of their licenses. 

The Collaborative Care Model is centered on five key pillars:

• Patient-centered team care

• Population-based care

• Measurement-based treatment to target

• Evidence-based care

• Accountable care

A report developed by the APA and APM provided evidence of the model’s success along with case use examples and recommendations on how clinicians can use the model to better meet the whole health needs of patients with mental health conditions.

Increasing Access to Psychiatric Care

Anna Ratzliff, MD, Ph.D., psychiatrist, and professor at the UW School of Medicine, said the Collaborative Care Model can help increase access to behavioral health by allowing psychiatrists or other psychiatric providers to provide consultation to the care team and treat a larger patient population than other types of psychiatric delivery models.

“This means that psychiatrists will be providing most of their care through indirect services to help that on-the-ground team really provide the direct services,” Ratzliff explained. “For example, if a patient came in for a common mental health disorder such as depression and anxiety, they would be seen by their primary care doctor and the behavioral health care manager. They would perform the initial assessment that might include measures to assess symptoms. Then, in collaboration with and consultation with the psychiatrist, they will establish a provisional diagnosis and develop a treatment plan.”

“In general, that means the psychiatrist is not the one directly seeing or prescribing to the patient, but actually supporting the team to do that,” she said. “They are really leveraging their expertise to allow them to serve more patients.”

This integrative model gives psychiatrists the ability to use their clinical knowledge to extend support to a broader population of patients, which Ratzliff noted is extremely important and timely. Current data shows that 96 percent of the counties in the United States have an unmet need for psychiatric providers and prescribers, she said.

“We feel this is one model that might help address some of that shortage in that if psychiatrists spent part of their time delivering care in this model, they are really helping teams be able to deliver care to a caseload of patients.”

Ratzliff suggests that in the future, psychiatrists may hold a traditional direct-service psychiatry practice for part of their time while working in the Collaborative Care Model to complement their current practice. 

The APA, in partnership with The University of Washington's AIMS (Advancing Integrated Mental Health Solutions) Center, has collaborated to deliver training and technical assistance on the model to about 3,500 psychiatrists over the last four years.

“Through this grant, the APA has built an extensive set of resources that are available on their website to support introducing this concept to psychiatry practices and to be able to provide support for advocacy at the state level for Medicaid to encourage payment and adoption of a new Collaborative Care code,” Ratzliff reported.

The APA also provides a variety of online resources for clinicians to get trained in the model, to get paid, and to implement the Collaborative Care model. The AIMS Center and APA also offer monthly office hours for providers needing help with supporting finance and billing of the Collaborative Care Model. 

“I really do believe this model opens up access to behavioral health care and psychiatric care,” Ratzliff said. “It really does provide access to psychiatric services where patients are most comfortable coming and where they may already have an established relationship.”

“The Collaborative Care Model does have a strong evidence-base,” she added. “It has been shown in over 100 randomized controls and trials that this is an effective model to treat patients.”

“Part of the reason that I think it is so effective is that we do measurement-based care,” Ratzliff concluded. “We continue to ask the question, ‘Is the treatment that we are offering getting the patient better, and if not, how should we change or intensify the treatment to get the job done?’ That part of Collaborative Care is really providing the infrastructure to ask that question consistently and make sure a change is implemented if needed. I think it also increases access to effective care, which is really important.”

STAFF CARE has part-time and full-time locum tenens positions for psychiatrists, physicians and advanced practitioners across the U.S.