Second, the program relies on a new, innovative way of paying for depression care. Through ICSI, health plans and medical groups have developed a new payment model by which medical groups receive a monthly fee from health plans to cover the costs of these additional care services. It's the first, fee-for-service reimbursement system for depression care in the nation, and it allows medical groups to fund the care manager and consulting psychiatrist services described above.
While DIAMOND is a Minnesota innovation, nearly 40 controlled trials have shown that similar collaborative methods of managing depression in primary care improve patient health. And a recent study suggests that costs for patients involved in programs like DIAMOND for one year are actually $3,300 less over the subsequent three years than they would have been.
And there is more collaboration happening in this area.
A number of behavioral health clinics, agencies, and groups throughout the state are participating in a collaborative in which they learn about best practices, share their successes and learn from their failures with depressed patients. Minnesota is unique for having frontline psychotherapists and psychiatrists create systems to routinely measure whether their care is truly helping their depressed patients, agree to publicly share their results, and hold themselves accountable to improve their care.
On a broader scale, MN Community Measurement is promoting the sharing of results for depressed patients throughout Minnesota. It has recently posted the results of depression care for 48 primary care clinics and six behavioral health clinics. We are in the early stages of working with this technically difficult measure and in some ways are still getting the bugs out. Since the results are delayed one year, the initial numbers primarily reflect baseline activities and imperfections in the measurement system. The numbers show that a state average of 4 percent of patients with depression are still being seen six months after beginning their treatment and have gotten better. That number may seem startlingly low, but it is almost identical to MN Community Measurement's starting point in establishing "best care" for diabetes. Steady improvement in diabetes care suggests similar progress is possible with other conditions.
All the clinics that courageously volunteered and agreed to participate are pioneers who are willing to put their time, effort, energy, and reputations out there to do a better job of caring for their patients. These are the clinics to watch in the future as their patient care and scores continue to improve. Minnesotans should feel proud for supporting these creative initiatives, which are being watched nationally. This quiet Minnesota revolution must not stop here. All stakeholders - public and private, partners and competitors alike - must continue to support necessary collaboration, measurement and improvement on a sustained basis.
Michael Trangle, M.D., is associate medical director of the behavioral health division of HealthPartners Medical Group and Regions Hospital. His e-mail address is michael.a.trangle@healthpartners.com
I would like to see something like this implemented, especially a care manager who would co-ordinate care and follow up with the patient, perhaps the family doctor, the therapist, even the insurance, to make sure that the paper work, treatment, medications and information is up to date. That the patient doesn't get lost, or feel lost, or neglected. Even feeling that someone was helping you in the system could make you feel better.
I think that often is the cause of someone stopping treatment, and the cost, of course. Something they appear to be also addressing. Without that, I'm afraid, it all falls apart. Thanks, Judy.