In the United States, over 40 million Americans (around one in five) have mental illness – making mental illness the number one cause of disability. This number continues to grow – with rates of clinical depression rising 15-20% in the last decade. This epidemic poses a huge cost to the healthcare system. Patients with mental illness cost the medical system 2-3x more per year in medical claims over a typical patient. This is a result of higher ER utilization, greater comorbidity burden, and increased doctors visits. The magnitude of this problem is daunting – but hints at the opportunity for Carbon Health to make a difference.
We’re excited to announce today that we are deploying an integrated model of mental healthcare – where patients can receive medication and brief therapy sessions for common mental health conditions such as depression, anxiety, and insomnia – all through a single care team composed of a primary care physician, a clinical social worker, and a consulting psychiatrist. This model of care is called Collaborative Care, or CoCM, and it will be available to our primary care patients across Carbon Health
The value proposition for a patient is clear – access to mental health services in days rather than months and affordable care where mental health is covered by your primary care insurance benefit.
CoCM is proven to deliver improved outcomes for mental disorders, reduce chronic disease indicators, and lower the overall cost of care. Beginning with the seminal IMPACT Trial published in 2002, more than 90 randomized controlled trials and several meta-analyses have shown Collaborative Care to be more effective than typical medical care for patients with depression, anxiety, and a range of other mental health conditions.
Despite the compelling evidence for CoCM over the past 30 years, adoption of CoCM in primary care has been limited and has faced a number of implementation barriers. Carbon Health is able to overcome some of these barriers because of our unique vertical integration of software and clinical operations and our close alignment with our providers. Through our mobile app, our mental health specialists can proactively reach out to patients; patients can also easily access their information, follow-up on action items, report how they’re feeling, and book urgent, primary or mental health care all from one place. All of this happens on the same Carbon app that patients use to access primary care and urgent care, so there is no friction of new accounts or passwords to traverse to access mental health. Through our custom EHR, providers utilize population health principles to identify and track progress, monitor patients that require more or less intervention, and seamlessly communicate with the patient’s primary care provider.
We’re optimistic that CoCM can be applicable in the wide array of settings we serve – from student health to women’s health to geriatric care. We recently published a paper in the journal Medicine where we expand upon this value.
We piloted our CoCM model with a cohort of 4 primary care providers in Massachusetts, which led to our decision to bring the program to more patients.
In the five months since rolling out the program, 17% of all of our primary care patients were referred from our panels to CoCM and 80% of those referred were enrolled into the program.
There has been a tremendous response to treatment for our CoCM patients. We have observed a 27% decrease in the PHQ-9 and a 28% decrease in the GAD-7 scores for the entire cohort. On average, 41% of patients with PHQ-9 greater than 10 and 42% of patients with GAD-7 scores greater than 10 have a 5+ decrease in their scores (which is deemed to be clinically significant). For those who have completed at least 2 months in the program, 53% of patients have had a 5+ point reduction in their PHQ scores and 60% have had a 5+ point decrease in GAD scores.
Beyond these clinical results, the patient feedback has been overwhelmingly positive.
“...the medication and help I have received from this team has been wonderful!! I
couldn’t be more happy with the care that I am receiving and know that I will get over this soon. I see signs of improvement every day”
“Went from severe to none. I could cry happy tears. Thank you all for your support.”
Mental health at Carbon Health is a major pillar of our Connective Care model where care is integrated and measurement-based.
Measurement-based care (MBC) refers to the systematic and evidence-based method of monitoring a patient’s progress through their treatment journey. Our clinicians use data to make objective and informed decisions about care. Unlike physical health, where quantitative assessments like blood pressure have been routinely monitored for years, measurement-based care has historically been challenging for the mental health field.
At Carbon Health, we’re making MBC better by routinely administering validated assessments (like the PHQ-9 or GAD-7) to patients through our mobile app. Our clinicians use this data to measure symptom severity, quality of life, functioning, and treatment feedback in real-time. Research has shown that continuous monitoring and feedback results in significant improvements in outcomes, nearly doubling therapeutic effect size.
MBC is impactful because it allows clinicians to recognize poor response to treatment and change trajectory. Assessment results are made visible via a “data cockpit” to both the patient and the clinician, thereby engaging our patients in their own healthcare decisions.
Although this is just a start, our measurement-based care program is paving the path forward to raising the standard of care; as of 2015 only 11% of psychologists and 18% of psychiatrists across the United States routinely used patient reported outcomes in care.
Carbon Health’s integrated mental health program – unlike traditional mental health services – are typically covered by most insurers under your medical insurance benefits. If your primary care visits are covered, your integrated mental health visits are too.
Not only does comprehensive coverage reduce access barriers, CoCM also benefits payors by reducing overall healthcare spend; Blue Cross Blue Shield of Michigan (BCBSMI), for example, spends 2-3x more on its members with behavioral health conditions. We’re excited to align all stakeholders around bringing scalable, accessible, and effective treatment options to market in a way that advances the quadruple aim.
To learn more about CoCM at Carbon Health, visit https://carbonhealth.com/get-care/mental-health-concern
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