Collaborative Care Opportunities for Psychiatrists

Integrating primary care and behavioral health is fast becoming a key component in the everyday delivery of health care. From state innovation model grants, to proposals for insurance companies to deliver Medicaid services, to the movement toward value-based purchasing and more, implementing evidence-based models of integrated care is a major force now and will be in the coming years. The most effective model in the primary care setting by far is the collaborative care model, with proven capacity to deliver on improved outcomes, lower overall health care costs, and increase patient and provider satisfaction with care. This model incorporates a behavioral care manager and consulting psychiatrist working in concert with a primary care provider to treat a variety of mild to moderate behavioral health conditions in the primary care setting. A measurement-based approach is at the heart of the model and uses weekly psychiatric consultation through caseload review to adjust treatment for patients who are not improving. After a decade of struggling with funding the nonbillable elements of this model—including psychiatric consultation—new billing codes are now available to compensate the team members for the time spent outside of routine care providing the critical components of the model. These new codes provide the ability for rapid dissemination of this model and will require psychiatrists to be ready to assume the important work of consultant, teacher, and leader. In the leadership role they will be invaluable in helping the team maintain fidelity to the collaborative care model and ensure effective implementation and maintenance of the core components.

The roles for psychiatrists in models of integrated care will continue to expand and move the field toward new approaches to leverage psychiatric expertise to effectively treat larger populations of those in need. While there will always be a need for direct care of patients with more severe behavioral health conditions, this change in practice will allow health care systems to provide more effective care in a period characterized by a marked shortage of psychiatrists. Psychiatrists are already preparing for these new roles, with the American Psychiatric Association training 3,500 with funding from a Transforming Clinical Practice Initiative grant, and residency training programs are beginning to respond to the shift in educational requirements. This well-equipped workforce will fundamentally change the way psychiatric services are provided.