A key component of interdisciplinary palliative care is addressing patients’ emotional health. For patients dealing with cancer, this is essential.

Research published in BMJ shows that cancer patients are at least twice as likely to experience depression and anxiety. According to a 2020 study by the Journal of Pain and Symptom Management, alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer were identified, exceeding those previously benchmarked and on par with noncancer patients with post-traumatic stress disorder. Of the individuals surveyed, 29.6% reported high levels of stress, 31.9% reported anxiety and 33.7% reported depression.

Get with the program

To tackle these psychosocial concerns, Rochester Regional Health’s Lipson Cancer Institute started Collaborative Care, a program that provides treatment plans for cancer patients experiencing symptoms such as anxiety and stress, depression and sadness, insomnia and irritability that can interfere with their lives daily.

The program is designed to meet each patient’s specific needs based upon where they are in the treatment process by providing an accurate assessment of psychological health, as well as developing counseling and interventional planning to counter the effects of their emotional distress.

Once they are referred to Collaborative Care, patients are given important tools and resources. The program connects them and their families to holistic therapy where they can participate in relaxation techniques, meditation, yoga and exercise and talk therapy, as well as medication management, which is prescribed in the system by a Rochester Regional Health provider. Patients may also be seen by palliative care teams when they are interested in the therapy and receive a referral.

Therapists will meet with the patient’s care team to review cases on a weekly basis and discuss recommendations for any changes in their care. The patient is always an active part of the decision.

Bethany Walton, senior oncology social worker and collaborative care therapist at the Lipson Cancer Institute, said Collaborative Care began in 2021 as an extension of the program already in place serving Rochester Regional Health’s Primary and OBGYN Offices. This was expanded to cover the Oncology and Palliative Care Departments.

“Building a Collaborative Care program provided the financial infrastructure to allow our team of social workers to expand our services and address many of the behavioral health needs of our patients, as well as our medical social work line,” Walton told Palliative Care News.

According to the American Psychiatric Association, significant research over the last three decades has identified the Collaborative Care Model as a particularly effective and efficient method for delivering integrated care. Walton said the Collaborative Care model has now been tested in more than 90 randomized controlled trials in the U.S. and abroad.

“It is widely agreed upon as the integrated care approach with the most robust evidence base,” Walton said. “It leads to significantly better clinical outcomes, greater patient and provider satisfaction, improved functioning, and reduces health care costs.”

Putting the plan together

The Collaborative Care program is being rolled out at six Lipson Cancer Institute locations, which will offer services by members of their care team who work closely with caregivers and palliative care colleagues to provide total assistance to patients and their families.

Implementing the program was a team effort according to Walton, who said it took partnering with leadership on the outpatient social work team, building infrastructure in the EMR, and working with the billing and coding team to be able to mirror the process already established in primary care.

“RRH worked with the leadership team, the Office of Mental Health NY, and the AIMS center to tackle set up,” Walton said. “The program currently works with Dr. Jennifer Richman, psychiatrist, to oversee cases and provide feedback on treatment and medication management, and regularly meets with the medical providers meeting with patients to ensure a steady stream of patients being referred.”

Patients eligible to participate in the program include 12 years old and up, oncology or hematology patients that have an active care team member through the Lipson Cancer Institute, patients comfortable with behavioral health information being shared with their medical team and who are not currently linked with a mental health provider, and patients willing to participate in screening tools such as the PHQ9 or GAD7 on a monthly basis.

Services offered through the program are reimbursed using Current Procedural Terminology (CPT) codes 99492, 99493, and 99494, and Healthcare Common Procedure Coding System (HCPCS) codes G2214. These standardized codes are widely accepted nomenclature to report medical services under public and private health insurance programs.

Collaborative effects

After two years of offering Collaborative Care, Walton said the Lipson Cancer Institute has witnessed improvement in patients.

“Through tracking and the monthly completion of behavioral health screenings, we can see that our patients’ scores on the PHQ9 and GAD7 are improving” she said. “When not improving, we review their case with our psychiatrist and receive treatment recommendations.”

Along with the benefits to patients, the Collaborative Care program has had a significant impact on the Institute itself, generating support for the medical center’s social work staff.

“The goal is for social work services to support itself independently within a system. This is difficult when a lot of the services provided by social workers are not part of a billing matrix,” Walton said. “Collaborative care meets the needs of many patients that are not able to follow through with a traditional therapy model. It supports the medical team providing a high quality of care through the lens of the whole person, and improves compliance with treatment and communication amongst all disciplines involved in care through RRH’s umbrella.”

When it comes to the future of the program, Walton said Rochester Regional Health is always looking to expand services. Currently, the team is integrating behavioral health into palliative and oncology care by offering patients Collaborative Care sessions in person, over the phone, or via video through a secure platform within their MyCare account. These services will be available to cancer patients who are in active treatment as well as those who are in remission.