Richard C. Veith is a professor at the University of Washington who discusses challenges in mental healthcare access and delivery models. He describes the collaborative care model developed at UW, which leverages integrated care teams including primary care providers, care managers, and consulting psychiatrists to improve outcomes. This model has shown success in improving treatment response rates and achieving the "Triple Aim" of better health, quality, and lower costs. Veith also discusses challenges in caring for those with autism spectrum disorder and questions if a collaborative care model and telehealth could help address some of these challenges by disseminating knowledge and building workforce capacity.

1. Richard C. Veith, MD
Richard D. & Bernice E. Tutt Professor in the Neurosciences
Psychiatry & Behavioral Sciences
Adjunct Professor, Global Health
University of Washington
COLLABORATIVE CARE IN
MENTAL HEALTH AND ASD
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2. DISCLOSURES
Employment: University of Washington
Richard D. and Bernice E. Tutt Professor in the Neurosciences
Chief of Psychiatric Services, UWMC
Professor, UW Psychiatry and Behavioral Sciences
Adjunct Professor, UW Global Health
Grant funding (current and recent)
HRSA Office for Advancement of Telehealth (Veith, RC - PI)
Enhancing Rural Primary Care Access to Mental Health and
Opioid Management Consultations in Washington Via
Telehealth $1,000,000; 9/2012-8/2016
2 R01 NR007755-06 (Mitchell, P - PI)
Psychosocial/Behavioral Intervention in Post-Stroke
Depression (PSD) $1,671,368; 7/2010-7/2014
Industry Sponsored Activities - None since 1998
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3. PRESENTATION OVERVIEW
• Behavioral health workforce/access/treatment
challenges in US
• Mental health care delivery in era of
healthcare reform
• Collaborative care model – leveraging scarce
resources
• ASD Education and Care Delivery Challenges
• ? integrated care model
• ? telehealth
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4. HOW DO WE MEET THESE CHALLENGES?
• Poor access to mental health specialty
care
o Insufficient numbers and maldistribution of
specialists
o Those with greatest need have fewest
resources
o Poor medical care access for those with
chronic mental illness
• Poor utilization of evidence-based treatments
• Inadequate training of primary care providers
• Stigma
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5. US HEALTHCARE REFORM IS PROMOTING CHANGES
• Affordable Care Act – “Obama Care”
o Triple Aim - better health; better quality;
reduced costs
• Focus on patient-centered ‘medical home’,
integrated care, inclusion of mental health
care
• Shifts in reimbursement priorities
o Emphasis on comprehensive care and outcomes
• Innovative mental health delivery models
developed at UW
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6. WHO DEFINITION OF HEALTH
Health is a state of
complete physical,
mental and social
well-being and not
merely the absence of
disease or infirmity
(1948).
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7. 20 years of Research and Practice
in Integrated Mental Health Care
DIVISION OF INTEGRATED CARE AND PUBLIC HEALTH
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8. UW CATCHMENT AREA -- WWAMIMI
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9. PRINCIPLES OF EFFECTIVE COLLABORATIVE
BEHAVIORAL HEALTH CARE – J. UNÜTZER, 2011
Patient Centered Team Care
• Team members collaborate effectively
Population-Based Care
• Patients are tracked in a registry: no one ‘falls through the cracks’
Measurement-Based Treatment to Target
• Treatments are actively changed until the clinical goals are achieved
Evidence-Based Care
• Treatments used are ‘evidence-based’
Accountable Care
• Providers are accountable and reimbursed for quality care and outcomes
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10. COLLABORATIVE TEAM APPROACH
J. UNÜTZER, 2011
General
Medical
Practitioner
Patient
Behavioral
Health
Care Manager
Consulting
Psychiatrist
Other Behavioral
Health Clinicians
Core
Program
Optional Additional
Clinic Resources
Outside
Resources
Substance Treatment, Vocational
Rehabilitation, CMHC,
Other Community Resources
New Roles
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11. DANIEL’S STORY
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12. WE CAN DOUBLE THE EFFECTIVENESS OF CARE
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8
Usual Care IMPACT
% with treatment response
Participating Organizations
Unützer et al., Psych Clin NA , 2004
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13. CARE MANAGEMENT TRACKING SYSTEM ©
CMTS
• Access from anywhere
• Population-based
• Supports effective care
• Keeps track of caseloads
• Facilitates consultation
• Allows research on highly
representative populations
• Licensed by UW C4C to 21
users in 14 states
• Has supported care of over
80,000 patients
Caseload summaries help manage clinical
productivity and quality improvement
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14. ACHIEVING THE TRIPLE AIM
Patient care
experience
Clinical outcomes
Health care costs
“I got my life back”
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15. COLLABORATIVE CARE AT UW MEDICINE
3 HMC
(CHPW
MHIP)
2008 2010 2012 2013
1 UWNC
4 UWNC
1 UWMC
1 UWNC
1 HMC
BHIP
Launch
11 Participating Sites
Harborview Medical Center (HMC)
Adult Medicine, Family Medicine, Pioneer Square, Women’s Clinic
UW Neighborhood Clinics (UWNC)
Belltown, Federal Way, Kent/Des Moines, Northgate, Ravenna,
Shoreline
UW Medicine Center (UWMC)
General Internal Medicine
2014
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16. WASHINGTON STATE
MENTAL HEALTH INTEGRATION PROGRAM
over 40,000 patients served
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17. UWNC PRIMARY CARE PHYSICIAN
“You have no idea how helpful it is for a
provider to have a resource like you in
the clinic. I practiced for 16 years without
it and I will never go back! You are such
a great support for all of us.”
Sept, 2013
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18. ASD: HOW DO WE ADDRESS THIS CHALLENGE?
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CDC: Surveillance Summaries. March 28, 2014 / 63(SS02);1-21

19. PROGRESS
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• Increased public awareness
• Improving health coverage
• Centers of excellence are advancing
knowledge and training future workforce
• Expanding educational and vocational
opportunities

20. CHALLENGES
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• How to disseminate knowledge
o Traditional educational venues
• Who will be the caregiver workforce?
o What skills, training do they need?
• Would a ‘collaborative care’ model be effective
o Do we have enough ‘experts’
o Who will serve as care coordinators
o How will this be financed and sustained?
• Can telehealth be employed for educational and
consultation outreach?
o Videoconference consultations
o Project ECHO – learning communities, case-based,
capacity building

21. Thank You
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