Case studies show how tool helps CMs
Monitoring progress allows you to adjust care
Pitney Bowes in Stamford, CT, saved $1.4 million in depression-related medical costs when in partnered with Integra, a behavioral health company in King of Prussia, PA. The case studies below illustrate how care managers use Integra's COMPASS mental health evaluation tool to monitor and adjust treatment plans.
Case study 1
A 49-year-old man presented with symptoms of depression, which included sadness, feelings of worthlessness, and difficulty concentrating and making decisions. The patient knew of no reason for his current depression. Medical records indicate he was hospitalized for depression five years earlier and was out of work three full months.
The network provider administered the COMPASS tool and reviewed the scores with the care manager after the employee's first session. Based on the patient's history, the care manager recommended a medical consult for antidepressant medication, but he refused to take medication. The care manager and network provider recommended family involvement in sessions to educate the patient and family about medication use. The patient changed his mind and agreed to take medication, but he showed only small improvement.
The care manager recommended an intensive outpatient protocol moving from weekly sessions to three additional sessions each month. By the 18th session, the patient returned to normal.
"There were several indicators on the patient's COMPASS score that directed the care manager's decision making throughout the course of treatment," notes Len Sperry, MD, PhD, vice chairman and professor of psychiatry and behavioral medicine at the Medical College of Wisconsin in Milwaukee and consulting medical officer for Integra. Those indicators include the following:
o The tool completed at patient's first visit indicated that therapy was essential for him. In addition, his distress level was in the extremely high range, and his emotional function was poor. He also reported that his confidence in treatment success was high.
o Between the first and eighth visit, the patient's score indicated his symptoms of depression had increased, but his life functioning had improved. After session eight, his sessions were increased. By session 18, his mental health had returned to normal.
"The patient's expectations are crucial to understanding his resistance to medication," Sperry says. "A review of his past history indicated that he had experienced strong side effects from antidepressant medications in the past. His resistance to take meds combined with his confidence in treatment success showed us that combined treatment was necessary. If we hadn't involved his wife, he may not have agreed to take meds."
The case also illustrates the need for flexibility in mental health benefits. "Those intense outpatient sessions between sessions eight and 18 were critical to turning this case around. When his treatment was adjusted, we saw results."
Case study 2
The second case was a divorced woman with a three-year history of depressive symptoms. She experienced excessive ruminations, inability to concentrate, and an overall decline in work performance. Before Integra inherited her case, the patient had been in weekly treatment for three years. Treatment included 50-minute weekly psychotherapy sessions and moderate levels of Prozac.
The first COMPASS tracking uncovered several critical issues, Sperry says. "She scored high for substance abuse. Strangely, treatment for substance abuse was not part of her current psychotherapy sessions," he notes. In addition, the patient rated treatment as only moderately important to recovering and reported only slight confidence that therapy would succeed.
The care manager and therapist shifted her treatment focus to substance abuse. The patient's well-being score jumped significantly between her first and second session following the treatment focus shift. However, her life functioning score declined.
The care manager explained the phase theory of psychiatric treatment to the therapist. The care manager reassured the therapist that it was normal to see immediate improvement in well-being scores and that this represented positive progress. The therapist was relieved to hear that life function rehabilitation takes considerably longer than improvements in well-being and reductions in resistance to therapy and that the care manager did not see the patient's decline in life function as a negative sign.
Treatment focus shifted to the employee's low areas of life functioning. The care manager urged the therapist to make a medical referral. In addition, the care manager received the patient's consent to contact the supervisor. The care manager consulted with the supervisor to make necessary changes in the workplace.
"A consultation with the supervisor in the workplace was essential," says Sperry. "This woman had gotten a reputation as someone who didn't hold up her end of the workload."
The employee remained at work throughout treatment. After more than three years of treatment, her depression began to show positive movement. Her work performance also improved. "This patient's case was more complex than our first case study. Still, if after 170 sessions of unsuccessful treatment you can begin to see something positive happening, you feel pretty good," Sperry says.
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