October 18, 2021
In the cult film The Adventures of Buckaroo Banzai Across the Eighth Dimension, Peter Weller stars as the titular character, a surgeon and physician who also fronts the wildly popular band The Hong Kong Cavaliers. During a scene in which he performs and narrates an intricate surgery, Banzai cautions a colleague, “Don’t tug on that. You never know what it might be attached to.”
Beyond the humor, the line illustrates the somewhat tragicomic conundrum of human health: Making changes to one aspect of human biology invariably has downstream effects.
And what goes for human physiology is just as true if not more so for human psychology. Tug on the psyche here and it messes with something over there.
Over time, this realization has informed an industry that now provides care in teams. Virtually no one still thinks effective mental health care is the product of one or two people’s efforts.
Why has coordinated care become the norm? In a word, comorbidities. It’s become obvious that the complex interplay of physical and mental ailments, as well as the impact of multiple mental health issues, requires different types of expertise and different levels of treatment.
The percentage of Medicare dollars spent on patients with four our more comorbid disorders could be as high as 93 percent. Some studies show that 60 percent of individuals diagnosed with an anxiety disorder also have symptoms of depression.
Don’t tug on that until you know what it’s attached to.
“So psychiatric diagnoses involve large numbers of interlocking symptoms and syndromes,” writes Dr. Mathew Edlund. “They affect all the biological and mental aspects of an individual. They’re systemic diseases. They generally last decades and are often generational.”
Behavioral health care has adopted a team approach because it’s the only strategy with a chance of success.
Fortunately, the technological support for this team approach is finally coming into its own after many years of numerous documents and thick patient files.
Many healthcare IT platforms now incorporate multi-disciplinary treatment planning (MDTP) or coordinated care planning applications that facilitate patient care among a diverse group of providers. What makes these tools so potentially beneficial in the provision of patient care? Primarily, they facilitate care the way it was designed.
Originally drawn up by the AIMS Center at the University of Washington, the coordinated care model incorporates five principles: the care provided is the product of a patient-centered team care, is population-based, focuses on measurement-based treatment, is evidence based, and is accountable. These principles don’t require an IT tool, but it makes adhering to them much easier, especially since less than 3 percent of psychiatrists and psychiatric nurse practitioners actively develop shared care plans with primary providers. Such tools are also particularly useful in a pandemic.
“With primary care increasingly delivered via video chats and secure messaging, CoCM [the coordinated care model] can capitalize on telemedicine to facilitate geographic flexibility for patients and clinicians in this virtual clinical space,” says a JAMA Psychiatry viewpoint. “Using the same technology, the CoCM team can communicate with PCPs as needed … Coupled with recent telehealth billing flexibility for physician services, this means that all facets of CoCM—including individual virtual visits between the patient and psychiatric consultant—are billable in the COVID-19 era.”
Whether or not this billing flexibility will endure remains to be seen, but it’s generally easier to implement a policy change than it is to eliminate one.
At a minimum, an effective treatment planning module must include the ability to create problems, goals, and interventions for use in treatment planning documentation. It must also give each member of the care team the ability to review actions by other care team members and sign off on relevant components. Treatment planning applications that can gather patient and provider signatures more effectively streamline the entire process, as does the automated inclusion of DSM 5 diagnoses in the patient chart.
While the collaborative care model is targeted at behavioral health care, it also reveals that healthcare in general is a team sport and that there are almost always downstream effects that require the expertise of more than one provider. Mental illness gets in the way of taking medications that can improve a behavioral issue and many chronic physical issues like diabetes. Chronic pain eventually creates the strong likelihood of depression. Some procedures improve one condition but exacerbate another.
All this speaks to what we already know: Humans are intricate, integrated organisms for whom simple solutions are often overly simplistic. As medicine makes tremendous technological leaps forward, it will to well to remember that virtually no patient treatment exists in a vacuum.
When you tug on something here, know what it will do over there.
Medsphere Systems Corporation provides robust information technology solutions and services for behavioral health, inpatient, and ambulatory environments. Among Medsphere’s products is a comprehensive Multi-Disciplinary Treatment Plan (MDTP) module that powers collaborative, patient-centered care and keeps all providers on the same page.