Two Years Later: DIAMOND Program Continues to Get Nearly 50% of Patients with Depression into Remission Within Six Months

Results Based on More Than 3,000 Patients Receiving Team-based Treatment in 83 Primary Care Clinics

BLOOMINGTON, Minn., June 25 /PRNewswire-USNewswire/ -- The DIAMOND program (Depression Improvement Across Minnesota, Offering a New Direction) continues to get at least five times as many patients into remission by six months than patients receiving typical primary care treatment, according to two-year findings reported today by the Institute for Clinical Systems Improvement (ICSI, www.icsi.org).  

Of the 1,752 patients contacted six months after entering into the DIAMOND program to date, 45% were in remission and another 16% had at least a 50% reduction in the severity of their depression.  An additional 1,285 DIAMOND patients unable to be reached at six months to determine their progress are presumed to be still depressed, although they could have gotten better. Using this measurement, 26% of DIAMOND clinic patients were in remission at six months, compared to only 5.8% of patients treated in 184 primary care and behavioral health clinics reporting in 2009 to MN Community Measurement, a nonprofit organization that publicly reports on medical group's quality results in Minnesota.

"Among the clinics reporting on patient outcomes stemming from their treatment plans, seven offering the DIAMOND program were in the top 10," said Jim Chase, president of MN Community Measurement.  "Mayo Clinic had two of the state's top performing clinics, and clinics run by Family HealthServices Minnesota, HealthPartners Medical Group and Allina Medical Clinic that also offered the DIAMOND program all posted top 10 results."

"What's exciting about our latest data is that we continue to see significant positive patient response to DIAMOND treatment after two years of implementation and across metro and rural clinics," says Nancy Jaeckels, ICSI vice president of member relations and strategic initiatives. "DIAMOND was modeled on a concept proven in almost 40 research studies; now our consistent results across thousands of patients demonstrate that this program is replicable in virtually any 'real world' setting." (A list of clinics offering DIAMOND can be found at www.icsi.org.)

The DIAMOND Program

Medical groups, health plans, employers, patients and the Minnesota Department of Human Services, under the auspices of ICSI, collaborated to develop the DIAMOND program. Launched in March 2008 through 10 clinics and now offered through a total of 83 primary care clinics, it is the first depression treatment program in the nation to integrate a collaborative care model with a reimbursement structure that enables medical groups to provide enhanced care support to patients with depression.

Key elements of the program, based on the IMPACT model created by Dr. Jurgen Unutzer, University of Washington, include: use of a standard assessment tool to improve the diagnosis and management of depression, the addition of a care manager and consulting psychiatrist to the patient's primary care treatment team, an evidence-based stepped-care approach to treatment, a tracking system to monitor follow-up care and treatment effectiveness, and tools to prevent the patient from relapsing back into depression. This extra bundle of care means the patient with depression is more frequently contacted, educated, encouraged and supported.

"Our two-year data also show that the DIAMOND program's approach to treatment—including involving patients in their own recovery and giving them tools to avoid falling back into depression—works.  Among 735 patients contacted a year after entering DIAMOND, 50% are in remission and another 17% have had at least a 50% reduction in the severity of their depression," says Jaeckels.

Payment Model

A key to the program's success has been a new payment model whereby medical groups receive a monthly fee from health plans to cover the costs of these additional care services. Without changes to the payment structure, medical groups would not be able to provide the care manager and consulting psychiatrist services to patients.

Health plans currently reimbursing clinics for delivering DIAMOND services include Blue Cross Blue Shield of Minnesota, HealthPartners, Mayo Clinic MMSI, Medica, Metropolitan Health Plan, PreferredOne, PrimeWest Health and UCare.

HealthPartners Research Foundation is nearing the halfway point of a five-year study on the DIAMOND program that is funded by a $3 million grant from the National Institute of Mental Health.  That study is evaluating all aspects of the initiative, including changes in care delivery, patient outcomes (including productivity effects), and health care cost-effectiveness.  The findings of that study will help determine the full value of the DIAMOND program.

"Our mission at ICSI is to improve the quality and lower the cost of care," said Kent Bottles, MD, president of ICSI.  "DIAMOND is an excellent example of how collaboration among medical groups, health plans, employers and patients enables us to deliver on that mission."

The Institute for Clinical Systems Improvement (www.icsi.org) is a non-profit health care improvement organization that brings diverse stakeholders together to find solutions to complex health care problems. Sponsored by six health plans in Minnesota and Wisconsin, ICSI helps its 56 medical group and hospital members deliver higher quality and lower cost health care.

SOURCE Institute for Clinical Systems Improvement

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