‘This is the future’

Meadows Institute leaders address APA’s Collaborative Care Model Residency Training Education Conference

JUNE 20, 2024

Meadows Institute Chief Medical Officer Dr. Roshni Koli addresses the APA’s Collaborative Care Model Residency Training Education Conference June 17 in Washington, D.C.

Dr. Sasidhar Gunturu was once a collaborative care skeptic, but his first experience with the integrated care model turned him into a champion.

It’s a story he tells every time he does grand rounds: While he was working as a consulting psychiatrist with a primary care practice, a patient went to one of the practice’s physicians and explained that she was having a depressive episode.

Molly (not her real name) was a recent high school graduate who had dropped out of college, taken a job as a barista and promptly quit that, too. She was in a downward spiral and needed help, but the stigma associated with seeing a psychiatrist discouraged her from seeking specialty care. For nearly three years, Molly was seen only in a primary care setting by her PCP, where she received subtherapeutic doses of antidepressant medication and her condition did not improve.

But when the depression care manager of that clinic presented the case to Gunturu, he immediately recognized that Molly’s prescribed dosage of sertraline was too low – “almost like water” – and he sent a secure message to the care manager via e-chat recommending that the practice double it. Within a few weeks of receiving the proper dosage of her medication, Molly went back to work and four months later she reenrolled in college.

“This is when I realized collaborative care really works,” Gunturu said.

Gunturu, vice chair of the department of psychiatry and director of psychiatric integrated services and residency program director at BronxCare Health System in Bronx, New York, did not attend the American Psychiatric Association’s annual Collaborative Care Model (CoCM) Residency Training Education Conference in June to be convinced of the benefits of participating in CoCM.

He already knew what a slew of expert speakers such as APA CEO and Medical Director Dr. Marketa Wills and Meadows Mental Health Policy Institute Chief Medical Officer Dr. Roshni Koli told the audience of more than 100 faculty members and residents from residency programs across the country: CoCM improves patient outcomes, increases provider satisfaction and has the potential to extend the treatment reach of prescribing clinicians to as many as eight times the number of patients that they could see in traditional one-on-one care.

“We believe this is the future,” said Koli.

Gunturu agreed. He said he came to the conference, which was co-sponsored by the Meadows Institute, Path Forward and the AIMS Center at the University of Washington, to learn more about CoCM financing so that the 11 collaborative care practices he oversees at BronxCare will continue to thrive even after their current grants expire. That’s why he was grateful for the “fantastic” introduction to collaborative care financing and billing provided by Sulamita Camargo, senior director of finance and health systems integration at the Meadows Institute.

In her presentation, Camargo explained that, as recent studies have shown, CoCM is financially sustainable, adding that Medicare has been reimbursing for CoCM through novel billing codes since 2018 and most major commercial payers have followed suit. State Medicaid plans are headed in the right direction, with 32 state Medicaid programs adopting the codes to date.

“Having this billing piece of the puzzle makes CoCM more sustainable,” Gunturu said, particularly as his health system looks to expand CoCM into pediatric settings.

During a pediatric CoCM discussion moderated by the Institute’s Koli, Dr. J. Nathan Copeland, an assistant professor in the department of psychiatry and behavioral science at Duke University, said that North Carolina pediatricians currently participating in CoCM practices “cannot imagine going back.” In a changing health care landscape in which pediatricians are increasingly being asked to provide mental health care, “to have this model is very attractive,” he stressed.

Fellow panelist Dr. Mya D. Sendak, a consulting associate in the department of pediatrics at Duke University, agreed. “It really does feel like a mental health crisis,” she said, with a typical provider seeing up to three suicidal patients a day, plus 20 other cases. “This program makes it sustainable for us, helps prevent burnout.”

From left: Dr. Marketa Wills, CEO and chief medical officer of the American Psychiatric Association, Dr. Anna Ratzliff, co-director of the AIMS Center at the University of Washington, Koli, Clare McNutt, vice president of primary care innovation at the Meadows Institute, Kristin Kroeger, chief of policy, programs and partnerships at the APA, and Dr. David Oslin, vice chair for veterans health and professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania