In 2005, Aetna began integrating medical and behavioral healthcare through three efforts, the PCP Initiative, the Medical Psychiatric High Risk Case Management Program (Med-Psych), and the Depression Disease Management Program. Results have been very positive.
The nationwide PCP Initiative began at the primary care level, since a large proportion of people with depression are treated entirely in the general medical setting. Aetna began giving incentives to primary care physicians (PCPs) to screen high-risk patients for depression, including individuals with diabetes, coronary artery disease, chronic back pain, and other chronic medical conditions associated with depression. Aetnas PCPs are encouraged to use the Patient Health questionnaire (PHQ-9) a validated 9-item questionnaire for depression during patient visits. When the PHQ-9 is used, PCPs are paid an additional 30 to 40% more for a routine visit.
In addition, the Medical Psychiatric High Risk Case Management Program (Med-Psych) brought greater integration of care for those with both medical and behavioral health problems. Case managers help in arranging appropriate and integrated care.
Aetna’s Depression Management Program provides clinical screening tools for PCPs as well as training for office staff, and it gives doctors access to a network of psychiatrists who are on call throughout the day to answer questions about treatment. Providers have access to Aetna nurse case managers and to Web-based continuing medical education programs on depression topics.
In the beginning of the effort to integrate behavioral and medical care, there was great concern about and attention paid to patient privacy issues. Experience has shown, however, that members view this proactive approach as a positive benefit. They are grateful for the outreach to them and much more likely to engage in more intensive care management through this tailored process.
