The DIAMOND Initiative
Program Location:
Saint Paul, MN
Payer Type:
Medicaid
Reported Outcomes
Description:
The DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative was pioneering work to change how care for patients with depression was delivered and paid for in primary care. The DIAMOND model was based on research (more than 37 randomized control trials) and built primarily around the components of the University of Washington AIMS Center’s IMPACT (Improving Mood: Providing Access to Collaborative Treatment) care model. The components of DIAMOND include: use of a care manager and consulting psychiatrist to support the primary care provider, screening for depression using the PHQ-9, use of a registry to monitor patient progress, intensification of treatment, and relapse prevention.
The DIAMOND model was implemented in almost 100 clinics. This was not an easy model to implement as it involves change on multiple levels in a given clinic, and several clinics dropped out over the years for various reasons. The care manager’s accessibility and flexibility allows for more frequent contacts with the patient and greater continuity of care than is possible with brief or infrequent physician visits. Care managers typically have backgrounds in nursing, social work or psychology, or a scertified medical assistants.
Click here for a detailed evaluation of the DIAMOND Initiative.
Payment Model:
The DIAMOND Steering Committee designed a payment model to support the initiative. A single billing code for DIAMOND services was established for use in certified DIAMOND clinics. The code covers care manager services, plus weekly consultation and case
review by the psychiatrist. The health plans negotiate the monthly reimbursement amount with each clinic in order to avoid any violation of anti-trust law.
Improved Health:
Journal of Ambulatory Care Management (Jan-March 2013)
- The DIAMOND response rate was 68.7 percent (versus 52.9 percent in usual care) and the remission rate was 52.7 percent (versus 31.3 percent in usual care) at six months
Other Outcomes:
American Journal of Managed Care (September 2014) (study of 14 medical groups implementing DIAMOND with 50 or more patients in the program)
Factors correlated with higher patient activation rates were:
- strong leadership support (0.63)
- well-defined and -implemented care manager roles (0.62)
- a strong primary care physician champion (0.60) and;
- an on-site and accessible care manager (0.59)
Remission rates at 6 months were correlated with:
- an engaged psychiatrist (0.62)
- not seeing operating costs as a barrier to participation (0.56) and;
- face-to-face communication (warm handoffs) between the care manager and primary care physician for new patients (0.54)
