In Brief

Two of the nation's largest managed-care companies are trying out a program that may facilitate collaboration between psychologists and physicians and help primary-care physicians better identify, treat and refer patients with psychological problems.

For the past five months, Humana Inc. has been testing Behavioral Disease Manager©, a telephone-based behavioral health assessment program that uses interactive voice technology to identify patients with behavioral health problems. Aetna Inc. will launch the assessment program in several Philadelphia primary-care practices this month. The tool seeks to help primary-care physicians--quickly becoming the "de facto mental health system in America," says one of its developers, psychologist Geoffrey Gray, PhD--make better decisions about mental health treatment.

"Primary-care physicians dispense a lot of care and make many referrals," says Gray. "But research shows they also underdiagnose mental illness and recommend inadequate treatment. So there is a compelling need to improve behavioral health delivery in the primary-care arena."

The tool will inform physicians when a referral to a psychologist is a better choice than a prescription, says Gray. It will boost referrals to psychologists and reduce unnecessary prescriptions, he adds.

Here's how the program works: When primary-care physicians suspect a patient may be suffering from a psychological problem such as depression, anxiety or substance abuse, they ask the patient to complete a series of questions using an interactive telephone system. A computer analyzes the patient's responses and sends the results via fax or e-mail to the physician's office within seconds. The results include diagnostic, treatment and medication recommendations, and indicate if a referral to a mental health professional is needed.

Patients complete follow-up assessments once a month so physicians can track their treatment progress. The program alerts physicians if patients aren't improving or adhering to treatment recommendations and includes feedback reports to patients as well as self-help aids for patients. The follow-up component will also enable psychologists to demonstrate the effectiveness of their services, says Gray.

The company behind the assessment program is OQ Services Inc., in Norwalk, Conn., which develops outcomes and disease management products for behavioral health and primary care and is run by Gray and psychologist Maureen Hart, PhD. They, along with David Brody, MD, based the tool on an outcome assessment instrument, the OQ®45.2, developed by psychologists Gary Burlingame, PhD, and Michael Lambert, PhD, of Brigham Young University. More than 100 U.S. university counseling centers, as well as numerous hospitals and medical centers, use that program to track the progress of patients receiving mental health treatment.

"This is not a replacement for a psychologist or a primary-care physician," says Gray. "It's a tool and should be thought of that way. It is a quality improvement system and will result in better integration between mental health and primary care and will identify patients who need referrals to psychologists and other mental health professionals."

Humana's pilot study is being conducted at its ChoiceCare plan unit in Cincinnati; Humana has 20 patients in the program so far and expects to test the assessment program with more than 200 patients in the next six months.

Several other insurers are interested in testing the program, says Gray. His company is developing an Internet version of the assessment program, which it expects will be up and running this fall.

--J. CHAMBERLIN