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ICSI helps guide Minnesotan medical groups implement depression care initiative

Institute For Clinical Systems Improvement : 28 May, 2008  (Company News)
The Institute for Clinical Systems Improvement (ICSI) is guiding ten primary care clinics in the Twin Cities, Duluth and Rochester to be the first in Minnesota to begin offering a new, more effective approach to caring for patients with depression.
To date, 234 patients have been enrolled in the programme - called Depression Improvement Across Minnesota, Offering a New Direction, or DIAMOND - since it began in March 2008.

The programme is the result of a collaboration between dozens of Minnesota medical groups, six regional health plans and the Minnesota Department of Human Services. Their efforts have been guided by the Institute for Clinical Systems Improvement (ICSI), a non-profit organization that brings medical groups, health plans, patients, health care purchasers and other constituencies together to develop solutions to problems in health care.

'DIAMOND is the first depression treatment programme in the nation to integrate a collaborative care model with an effective, sustainable reimbursement structure that enables medical groups to provide outreach and enhanced care support to patients with depression,' said John Sakowski, interim president of ICSI.

Key elements of DIAMOND include use of a standard assessment tool to improve the diagnosis and management of depression in the primary care clinic, the addition of a care manager and consulting psychiatrist to the patient's treatment team, tools to prevent the patient from relapsing, and a tracking system to monitor follow-up care and treatment effectiveness. The model allows for comprehensive care with constant information sharing among the care providers.

Currently 10 clinic locations of five medical groups are participating in DIAMOND:

- Community-University Health Care Center: Minneapolis clinic

- Family HealthServices Minnesota: Vadnais Heights, Banning, Gorman and Highland Park clinics

- Mayo Clinic: Northwest Rochester primary care clinic

- SuperiorHealth Center: Piedmont and Proctor clinics, both in the Duluth area

- HealthPartners Medical Group and Clinics: Arden Hills and White Bear Lake clinic locations.

Additional medical groups and clinics are completing training and other preparations through ICSI to become certified to offer the program. At least 90 primary care clinics in large and small communities across Minnesota and northern Wisconsin plan to be using the DIAMOND model by March 2010.

'Primary care has struggled to bring the highest quality of care to patients with depression because it lacks the resources or, at times, the training to treat them effectively,' said Tim Hernandez, MD, medical director, Family HealthServices Minnesota. 'The DIAMOND team approach with the care manager and consulting psychiatrist will help primary care providers do a better job and bring the most effective care to the patient.'

Clinical trials have demonstrated that use of this model in the primary care setting reduces the incidence of suicidal thoughts, puts patients in remission faster, results in 100 additional productive days over a two-year period, and reduces health care costs by more than $3,000 over a four-year period compared to patients who receive the usual primary care treatment and/or referral approach for depression.

DIAMOND requires medical groups to establish a care manager role and make other changes in their depression care practices. Through ICSI, health plans and medical groups worked together on a new pay model whereby medical groups receive a periodic fee from health plans that covers the costs of these services. The health plans and medical groups negotiated the reimbursement rates individually. Without changes to payment structures, medical groups would not be able to provide the care manager and consulting psychiatrist services to patients.

'DIAMOND shows that much can be accomplished through collaboration,' said Sakowski. 'It is an excellent example of how Minnesotans can benefit from care that is both patient-centred and value-driven.'

ICSI is gathering data and monitoring DIAMOND patient outcomes. The National Institute of Mental Health has also awarded HealthPartners Research Foundation a $3 million grant to study the DIAMOND initiative and its results over five years, including patient satisfaction, productivity and programme cost-effectiveness.

'Our work will determine the potential for DIAMOND to become the standard for depression care nationally,' said Nancy Jaeckels, ICSI's director of education and resources for improvement. 'It could ultimately be the basis for fundamental changes in our approach to managing chronic diseases, like diabetes, in the future.'
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