Tailored Mental Health Management Support for Primary Care (TaMMS)

The Tailored Mental Health Management Support for Primary Care (TaMMS) intervention is a new program designed to help manage the treatment of depression and anxiety for patients treated in four safety net clinics in Washtenaw County. TaMMS combines, for the first time, several care management services for depression that were developed separately at the University of Michigan to provide flexible, coordinated, and affordable services for patients with depression/anxiety treated in primary care.

All the essential elements of evidence-based collaborative care for depression are present in TaMMS, including (1) measurement based care, where patients’ symptoms and response to treatment are routinely assessed; 2) care coordination, where patients’ receipt of care and their treatment adherence are assessed, their self-management supported, and progress reports sent to providers; and 3) “treatment to target,” where patients who fail to improve receive additional psychiatric review and recommendations. TaMMS components will be tailored to complement existing clinic resources to ensure optimal use of all mental health support resources.
TaMMS will be implemented and evaluated over two years in four safety net clinics in Washtenaw County: Packard Health, the University of Michigan’s Taubman General Medicine and Ypsilanti Health Center, and the St. Joseph Mercy Health System’s Academic Internal Medicine (AIM) clinic.

All clinics serve mainly low-income and uninsured patients. Together in 2010, these four clinics treated nearly 18,000 low-income patients. Approximately 25% (4,500) of these patients are estimated to have depression or anxiety, and we expect that approximately 40% of patients with anxiety and depression (1,800) in these clinics will benefit from the TaMMS program.

The TaMMS program was developed as part of the Washtenaw Health Initiative (WHI), a voluntary, county-wide collaboration that has the goals of improving access to health insurance coverage and to high quality, coordinated care for low income, uninsured, and Medicaid populations. More than 70 healthcare, provider, and governmental organizations across Washtenaw County work together to form the WHI, including the University of Michigan Health System, Saint Joseph Mercy Health System, the VA Ann Arbor Healthcare System, the Washtenaw Health Plan, Washtenaw County government, and Washtenaw safety net healthcare providers. The Center for Healthcare Research & Transformation facilitates and staffs the WHI. The WHI steering committee and a multi-disciplinary mental health working group of the WHI agreed that safety net primary care clinics with limited resources should prioritize evidence-based and population-based initiatives. The TaMMS intervention is an innovative variation on proven evidence-based care management, but implemented here across three different health care systems collaborating in this county-wide initiative. TaMMS currently receives funding from WHI sponsors, Blue Cross Blue Shield of Michigan (BCBSM) Foundation, Michigan’s Medicaid Match, and a Michigan Department of Community Health Healthy Innovations Grant.