Randomized controlled trial of a health plan-level mood disorders psychosocial intervention for solo or small practices

Amy M Kilbourne, Kristina M Nord, Julia Kyle, Celeste Van Poppelen, David E Goodrich, Hyungjin Myra Kim, Daniel Eisenberg, Hyong Un, Mark S Bauer, Amy M Kilbourne, Kristina M Nord, Julia Kyle, Celeste Van Poppelen, David E Goodrich, Hyungjin Myra Kim, Daniel Eisenberg, Hyong Un, Mark S Bauer

Abstract

Background: Mood disorders represent the most expensive mental disorders for employer-based commercial health plans. Collaborative care models are effective in treating chronic physical and mental illnesses at little to no net healthcare cost, but to date have primarily been implemented by larger healthcare organizations in facility-based models. The majority of practices providing commercially insured care are far too small to implement such models. Health plan-level collaborative care treatment can address this unmet need. The goal of this study is to implement at the national commercial health plan level a collaborative care model to improve outcomes for persons with mood disorders.

Methods/design: A randomized controlled trial of a collaborative care model versus usual care will be conducted among beneficiaries of a large national health plan from across the country seen by primary care or behavioral health practices. At discharge 344 patients identified by health plan claims as hospitalized for unipolar depression or bipolar disorder will be randomized to receive collaborative care (patient phone-based self-management support, care management, and guideline dissemination to practices delivered by a plan-level care manager) or usual care from their provider. Primary outcomes are changes in mood symptoms and mental health-related quality of life at 12 months. Secondary outcomes include rehospitalization, receipt of guideline-concordant care, and work productivity.

Discussion: This study will determine whether a collaborative care model for mood disorders delivered at the national health plan level improves outcomes compared to usual care, and will inform a business case for collaborative care models for these settings that can reach patients wherever they receive treatment.

Trial registration: ClinicalTrials.gov Identifier: NCT02041962; registered January 3, 2014.

Keywords: Care management; Depression; Health behavior change; Health plans.

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Figure 1
Consort flow diagram.

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