How MetroHealth launched the collaborative care model
MetroHealth launched the collaborative care model at the end of June 2016 with three providers. Before launch, the entire clinic team had been educated not only on the importance of identifying and treating depression but also how the collaborative care model could improve on both. We worked closely with our informatics team to build the logic so that the PHQ2/9 would show at proper times on the health maintenance list as well as print at the time of check-in. Support staff were trained on new workflows, including the front desk staff, nursing staff, physicians, and medical case managers. Immediately before launch, the specific protocol was reviewed with personnel from the team.
We chose to roll out 2-3 providers every three months so that a) there was time to adjust, learn, and refine the workflows b) not overwhelm the behavioral health care managers with new referrals and c) get the intervention to all patients with a year. We also decided not to screen a patient until they have been in our care for at least 3 months so that we continue to address adjusting to a new diagnosis separately.
Finding the right candidate for the BHM role can be challenging as this role is more than a medical case manager but not a counselor or therapist. The BHM should be familiar with behavioral health assessments and care coordination but does not need counseling experience. In smaller volume clinics, this could be part of what a staff’s role is.
The most significant hurdle to implementation at first was process change and technology. Initially, the paperwork did not consistently print, or was not given to the patient, or failed to be entered in the chart. Some of this stemmed from changes in staffing after implementation and a physical move of the clinic during implementation. Patients at first were reluctant to see an additional person, but as the BHMs continued as part of the team, trust was built, and they were accepted and requested by the patients. After completing the screening or re-measurement, the BHM often meets with the patient before the patient sees the provider. This prevents patients from having to extend their visits and allows the BHM to collect critical information to share with the provider, expediting the overall visit. Occasionally, the BHM, provider, and patient meet as a group, allowing the entire team to hear the same information at the same time. Frequently, multiple patients with needs are in the clinic at the same time, necessitating the BHM to triage needs and schedule follow up with patients to dive deeper into issues. Additionally, finding space and time for an extra staff member to meet with a patient in the exam room can be challenging. Our BHMs need to be flexible and respectful of the provider’s needs for other regularly scheduled clinic patients.