Depression Care Management from Implementation to Expansion: “No More Wasted Years”

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https://doi.org/10.7812/TPP/17-140-08

Introduction: With limited resources in specialty Behavioral Health, we sought creative solutions to provide care for the growing population of patients with depression. Implementing a Depression Care Management (DCM) program was the first step in standardizing the criteria for the diagnosis of depression, decreasing treatment variability, assuring adequate monitoring of symptoms, and assessing for remission or relapse. In addition to enrolling “typical” Primary Care patients with newly diagnosed depression, we also reached out and enrolled more vulnerable populations with depression, such as Medicare members, postpartum women, adolescents, and those with multiple comorbid medical conditions.
Objective: To assess the effectiveness of a DCM program consisting of Registered Nurse Care Coordinators using proactive telephone and e-mail (kp.org) outreach to monitor and manage medications for patients recently started on an antidepressant. The patient health questionnaire-9 (PHQ-9) depression score was tracked, and standardized outreach and treatment protocols were followed.
Methods: A retrospective analysis was conducted using 908 patients enrolled in DCM, from January 2012 through August 2014, and a comparison group of 5468 patients. Outcomes were controlled for age, sex, health status, line of business, number of Behavioral Health visits, and baseline PHQ-9 score.
A financial analysis of the DCM program was completed in 2015 (based on 2012 through 2014 enrollments).
Results: Despite starting with similarly elevated PHQ-9 depression scores at baseline, within 3 months of enrollment, DCM participants’ PHQ-9 scores were lower than the comparison group (adjusted mean score of 4.7 versus 9.4, respectively). The depression symptom improvement was sustained over time, and there was significant gratitude expressed by DCM enrollees for the thoughtful and thorough care. In addition, patients enrolled in DCM were screened for bipolar disorder, substance abuse, and suicidality—and referred appropriately when needed.
With the top and bottom 5% “outliers” excluded, the total per member per month (PMPM) costs were affected with an average of $62 PMPM savings for the 12 months post-DCM enrollment compared with a matched comparison group of depressed patients not enrolled in DCM.
Conclusion: DCM, using evidenced-based protocols in a virtual, telephonic setting is highly effective in reducing PHQ-9 scores, improving patient symptoms, and controlling costs for patients with depression. The clinical outcomes of this DCM program are seen quickly and remain sustained over time.