In an attempt to improve depression outcomes, stakeholders in managed behavioral health have adopted a number of treatment strategies, both time-tested and novel. At the foundation of these trends in managed behavioral health is a renewed emphasis on early and appropriate treatment for depression. Clinicians, backed by the recommendations of the American Psychiatric Association (APA), should be initiating continuous aggressive therapy upon the diagnosis of depression, and this therapy should continue until complete resolution of depressive symptoms. In cases where patients are unresponsive to initial antidepressant therapy, a trial of another agent in the same class may be warranted, followed by a class switch if further unresponsiveness is observed.
Performance-based measures are gaining popularity in managed care and now stand to be employed in managed behavioral health as well. Based on the strategy of granting incentives to providers that adhere to specific standards of care, performance-based measures may demonstrate worth in improving medication adherence and adequate follow-up among depressed patients. The widely accepted and guideline-based Health Plan Employer Data and Information Set (HEDIS) Antidepressant Medication Management (AMM) measures provide an ideal starting metric for such performance-based programs in managed behavioral health.
Beyond a plan- and provider-centered strategy for improving depression treatment, managed care stakeholders are beginning to recognize the integral role of the patient in determining his or her own outcomes. The trend of employing patient empowerment interventions, such as motivational interviewing and collaborative care, reflects this recognition of the patient's role in managed behavioral health. By encouraging patients to take an active role in their treatment through support and education, outcomes may be significantly improved at minimal initial costs.