Ep 59 – Implementing a Collaborative Care Model (CoCM) to Improve Behavioral Health Outcomes, with Matt Miclette, RN

Our guest this week, Matt Miclette, is military veteran and a psychiatric and mental health board certified registered nurse. He is the Senior Director of Clinical Operations at NeuroFlow – a digital health company that provides an industry-leading solution for Technology-Enabled Psychiatric Collaborative Care.  Matt is also the Co-Founder and Executive Director of a nonprofit organization called Action Tank.  As a recipient of the prestigious Pat Tillman military scholarship, Matt is living with the passion that Pat Tillman spoke of, “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits … A passion for life is contagious and uplifting.” Matt’s passion is bright and shines through in his service for people with mental health needs.

In value-based care, it is clear that primary care is at the tip of the spear in dealing with Ambulatory Care Sensitive Conditions like CHF, COPD, and diabetes that drive up costs. In that model for managing chronic disease, the position of primary care providers being upstream to specialists allows them to curb 80-90% of healthcare costs by preventing unnecessary specialist visits and avoidable inpatient stays and ED visits.  With behavior health, it is a little bit different though.  Behavioral health conditions (for the most part) can’t be addressed by specialists because there aren’t any access points for them to even be seen! Although 70% of primary care appointments include problems with significant psychosocial issues, less than half of those receive any mental health treatment at all, because there is a such a shortage of specialists. To put this in context, the Substance Abuse and Mental Health Services Administration estimates that by 2025, the U.S. will have a shortage of over 15k psychiatrists and 26k mental health counselors!

Research shows that a Psychiatric Collaborative Care Model (CoCM) is an effective and efficient way of delivering integrated care for more complex patient behavioral health needs – CoCM is a model that enhances “usual” primary care by adding two key services: care management support for patients receiving behavioral health treatment and regular psychiatric inter-specialty consultation to the primary care team. Join us as we consider this and other important solutions with Matt in this week’s race to value!

Episode Bookmarks:

04:45 “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits.” – Pat Tillman

05:40 Matt discusses the inspiration of Pat Tillman and his passion into lifelong learning

06:00 How caring for wounded warriors recovering from combat trauma drove Matt’s future work in treating the “indivisible injuries” impacting behavior health

07:00 Realizing the stigma associated with behavior health from his time leading a military psych unit in Fort Hood

07:50 Making an impact through facility-level hospital policy, e.g. 75% reduction in restraint use

08:10 Matt discusses his experience working in public health policy related to substance use disorder

08:30 A shared passion for “changing the world” with Christopher Molaro, CEO/Co-Founder of Neuroflow

09:30 Alarming stats about behavioral health and SUD in our country!

11:10 Matt on the recent CDC report showing that the U.S. hit the highest level of annual overdose deaths ever recorded (93,000) – a 30% increase from prior year!

11:45 “The shortage of mental health providers is most acutely seen in rural communities. Over 50% of the counties in the U.S. don’t have a single psychiatrist.”

12:05 Understanding the population and identifying which individuals have the most acute behavioral health needs through upfront screening and measurement-based care

13:00 Matt explains how we can more effectively use primary care and interdisciplinary teams to treat behavior health issues

15:30 The Psychiatric Collaborative Care Model (CoCM) as an approach to enhancing primary care to deliver integrated care for patients with complex behavioral health needs

16:30 Implementation of integrated behavioral health and the importance of physician champions and C-Suite buy-in

18:00 “Psychiatric Collaborative Care is a stepped care model which means we get the right patient to the right level of care.”

18:55 Matt discusses the advantages of the CoCM in providing team-based care, outcomes measurement, goal setting, and behavioral health activation

22:00 The importance of structural measures like program enrollment and caseload size to assess the performance of integrated behavioral health models

23:30 Screening for social determinants (e.g. food insecurity, housing insecurity, loneliness) during the intake process for collaborative care

25:30 The cost savings impacts of effective integration of medical and behavioral services

27:20 The policy window for addressing behavioral health is open, and the time is now to lower healthcare costs (those with BH issues are 2-3X more expensive)

27:50 Referencing the IMPACT Trial (one of the most famous Collaborative Care studies) showing a six-fold ROI in CoCM implementation

28:30 Success stories in healthcare cost savings with behavior health integration

29:30 Leveraging FFS in the short-term as an incentive to stand up a CoCM program

29:50 Matt discusses how Health First is using universal screening and cloud-based registry solutions to ensure more effective delivery of Collaborative Care

32:00 Matt discusses the perceived risks of remote suicide screening and how technology can be used to link resources to patients in need

34:30 Setting yourself up for success in CoCM implementation through rapid deployment and a full patient registry

34:50 Remote screening for PHQ-9 assessments (Care Manager-led vs. Tech-enabled)

36:00 The importance of integrated BH technology to provide a hub for documentation, planned interventions, risk stratification, time tracking, and digital homework for patients

36:30 PCP workflow integration through EHR integration

38:40 Matt discusses important Neuroflow partnerships with Prudential, US Air Force, and Stop Soldier Suicide as examples of technology-enabled behavioral health integration

42:25 Matt reflects on his own experience with provider burnout while working at the Walter Reed National Military Medical Center

43:00 The need to care for the mental health of providers and how team-based care and technology can help

45:30 Matt provides his parting thoughts with involving the care team in the development of consumer technologies in the healthcare setting