The Collaborative Care Model

After a several months hiatus from contributing, I really struggled as to where to put the focus on this month’s contribution. Should I talk about the changing landscape with a new administration? The efforts to rebuild our state government? The hot-button issues?

I went back and thought about what has resonated in the past and decided I would talk about behavioral health and my favorite bill that I have in the legislature this session. Once again, I will add a caveat to this column with the advice I was given when first I entered office: never fall in love with your bills. I have repeatedly violated this advice, and this year is no exception. So, in this first column of our 2023 session, I’m going to talk about the Collaborative Care Model and our efforts to expand our pilot to a statewide effort.

As frequent readers are aware, I’m on the Health and Government Operations Committee, and recently I was appointed subcommittee chair of the Public Health and Minority Health Disparities Subcommittee. In our committee, we hear about the mental health crisis and deficit of services nearly every day, and many of us hear from our constituents asking for greater access to behavioral health care outside of crisis and emergency department settings. At times, it can feel as though we are operating continually in crisis without a means to move into prevention or even management of illness.

Maryland has been a leader in this effort, and in 2018, the Maryland General Assembly created a pilot for the Collaborative Care Model for Medicaid recipients, which creates a care coordination team to provide behavioral health care and resources in primary care settings. This model already exists for private insurers, but we didn’t have it as an option for our most vulnerable Marylanders. The Collaborative Care Model integrates physical and behavioral health services in primary care settings with care coordination and management, regular monitoring and treatment, and systematic psychiatric caseload reviews and consultation for patients who do not show clinical improvement. It is team based, patient centered, measurement based, evidence driven, cost effective and integrated care. In short, collaborative care brings behavioral health care, management and prevention to a comfortable setting where patients are most likely to utilize them, addressing the needs of the whole person.

This year, I, along with my Senate partner, Senator Malcolm Augustine, introduced House Bill 48/Senate Bill 101 — the Collaborative Care Model pilot expansion for Medicaid recipients.

Why now? Because the need is great, exacerbated by COVID but created by decades of disinvestment in and stigmatization of behavioral health care. Providing services in primary care settings normalizes and destigmatizes treatment for behavioral health disorders, encouraging patients to seek care in their regular primary care clinics, resulting in improved patient outcomes.

The Collaborative Care Model also allows Maryland to leverage state dollars for a 60/40 federal match, reducing the burden to the state. In fact, a 2019 report from the Healthcare Financial Management Association identified preventable emergency department visits at a cost of $8.3 billion annually with the biggest driver of unnecessary emergency department use being mental health care. The return on investment in the Collaborative Care Model is about $6 for every dollar spent.

I am not being hyperbolic when I say expansion of the Collaborative Care Model will be a gamechanger for our state and, more importantly, for our district. I look forward to bringing this essential health policy across the threshold for Maryland and District 33.