Last week the Foundation sponsored something of a coming out party for the Advancing Integrated Mental Health Solutions (AIMS) Center at the University of Washington School of Medicine. AIMS is dedicated to helping health systems implement evidence-based collaborative care programs for mental health or substance abuse problems. Like a human debutante, AIMS is young. It’s about two years old, with an illustrious pedigree--it is a child of the IMPACT trial of primary-care based collaborative care for depression in older adults, which is still the largest randomized controlled trial for depression ever conducted in the U.S. AIMS also sports an excellent education, polished in the finishing school of real-world technical assistance: it has supported the adoption of the collaborative care model by more than 570 clinics and systems of care, training over 4,000 providers.

The timing of AIM’s emergence wasn’t driven by the arrival of the spring social season, but rather by the need to be sure that AIMS’s work and lessons are connected to the current efforts to redesign the delivery system in health care reform. As the offspring of the prestigious families of the Chronic Care model developed by Ed Wagner and the Collaborative Care models (TEAMCare) of depression treatment pioneered by Wayne Katon and Elizabeth Lin, AIMS has a lot to contribute to new delivery systems that may become possible within the reimbursement models of medical homes or accountable care organizations (ACOs).

Fundamentally, the beauty of the integrated mental health model (such as MHIP or Respect-Mil) is that it pays careful attention to a key set of clinical care functions that can radically improve patient health outcomes and reduce the costs of care, including, but not limited to, older adults. These functions include systematic, frequent tracking of condition status; strong education and support for patient engagement; preparation for “stepped” modifications of a well-defined treatment plan to achieve target outcomes; facilitated access to evidence-based psychotherapy; and the availability of expert consultation where needed.

The effects of these combined functions are dramatic. In the IMPACT trial, in each of eight clinical sites around the country, the benefits of usual care (which usually included anti-depressants) were doubled for older adults with differing socioeconomic status and a wide range of additional diseases and conditions. IMPACT is also effective for other population groups. In new (to me) data shown at the meeting (I mean, cotillion) the collaborative care model was able to reduce recovery time for a Medicaid population of new mothers from a mean of 56 weeks down to 10. Think of the benefits to the mothers, children, and society of that additional 10 months of health and function versus depression and despair.

Depression, anxiety, substance abuse, and other behavioral health problems are common in primary care. Depression and anxiety alone affect 10-20% of the primary care patient population, and they are even more common among patients with certain other chronic conditions. Such patients are costly, 50 to 100 percent more expensive across all categories of health care services. Yet usual care is low quality, fragmented, and too often unsuccessful. Happily, the models that AIMS supports show that it doesn’t have to be this way. These models also point to the right way to care for other chronic conditions like arthritis, diabetes, and congestive heart failure, where the same functions of patient engagement, proactive tracking, and planned treatment modification can improve outcomes.

So we hope that many, many medical homes and ACOs will meet AIMS and become suitors, learning the skills and systems necessary to implement an integrated mental health solution. Without the capacity to provide this level of care within a primary-care based system, I don’t see how medical homes and ACOs can achieve their stated aims of providing evidence-based care and producing better health outcomes while also lowering the costs of care.