The Collaborative Care Model has the most evidence among integration models to demonstrate its effective and efficient integration in terms of controlling costs, improving access, improving clinical outcomes, and increasing patient satisfaction in a variety of primary care settings – rural, urban, and among veterans. Multiple studies show that having a psychiatrist to provide caseload consultation to a care manager who coordinates with patients and a PCP is an essential element of the model and correlates with improved outcomes.
Los Angeles County’s public mental health system was able to transform service delivery in response to well-funded policy mandates. For providers, a structure emphasizing accountability and patient centeredness was associated with greater stress, despite smaller caseloads. For clients, service structure and volume created opportunities to build stronger provider-client relationships and address their needs and goals. The Affordable Care Act (ACA) (1) is transforming health care delivery throughout the United States, increasing access for previously unserved populations and encouraging health care systems to provide coordinated, patient-centered care for chronic conditions to improve outcomes and reduce costs (http://innovation.cms.gov). For California’s public mental health system, large-scale transformation began earlier, in 2004, when voters passed Proposition 63, the Mental Health Services Act (MHSA) (2).