Mr. Smith (ICSI/DIAMOND) Goes to Washington

I’m sitting in the airport in Washington, DC after having been invited to participate in a two-day workshop put on by NIH, in combination with practically every other acronym-associated national health agency I’m aware of, and perhaps some with which I’m not.  It’s a bit heady for a long-time small town internist who’s had the unique opportunity to work at ICSI for 8 ½ years.

I’m reflecting on the past two days, and while it’s premature, I’m struck by a couple of thoughts that I need to allow to germinate and develop.  The workshop was organized to address the need to create an understanding of what research agenda questions should be addressed to advance the ability to provide behavioral health interventions in the primary care arena.

In all honesty, I sensed it was an effort to move across Washington-based bureaucratic organizations and begin to identify the types of activities which needed support from NIH, NIMH, NIDA, CMS, NIAAA, AHRQ, and more which should be included.  It was perhaps the first meeting where representatives from all these groups were in the same room, and more importantly to me, available for conversation.

First, just being in the room was somewhat of an event, and if you’re wired like me, there was an overarching question in my brain—what in the world was a QI guy, an implementer, doing at a research meeting?  In addition, I was asked to present to the group (very august, well-respected and known in the research world) on health care organizations’ perspective on the research gaps which needed to be addressed.  I was comforted by the fact that I was partnered with Richard Frank, a well-known economist, now embedded in an official position in Washington.  Of course, the evening before the meeting, as I arrived in Washington at midnight, I was informed he was unable to attend and I was on my own.

It’s now done, and was quite the experience.  First, my invitation wasn’t about me, but about ICSI, and the work we’ve done with our DIAMOND program for patients with depression.  It’s funny how when you’re buried in the day-to-day activities of this program, you begin to take for granted the work you’re undertaking.  As I presented an overview of DIAMOND, it was apparent that this piece of work is regarded by many as a sentinel, almost unprecedented activity.  Having successfully kept six commercial payers engaged (much to their credit), developing multiple protocols, job descriptions, training methods, measurements, criteria, and any other sundry supporting materials, it is obvious that the fact we have 80+ clinic sites with more than 4,000 patients involved in the program, is a result to be extremely proud of.

While we may lose sight of the magnitude of the effort, it is rewarding to get outside the local environment, and get an “objective” perspective—often times approaching a sense of awe.  Well aware of the limitations of this as a complete solution to the multiple problems of health care, it is an amazing story of which all of us in Minnesota should be proud.

Why is DIAMOND important?  I believe it provides an incredible opportunity to advance our work in transforming the health care system, and  begin to identify the needed knowledge which will be essential in advancing our ability to integrate mental/behavioral health into primary care, advance the health care home concept, move toward a patient-centered holistic model, and support the needed transformations in our dysfunctional system.

I met an assortment of intelligent, committed individuals, with unique lenses on the issues, intense passion, and a commitment to learning more about the research needed—and hopefully identifying that it will be a different type of research if we’re to truly move the system more rapidly in the direction it needs to go, but yet supported by a research agenda.

If we’re to truly advance what we’ve learned from DIAMOND, we’ll need to engage national payers (specifically the Medicare FFS population), learn more about the organizational culture issues which must be addressed, and better understand the challenges of engaging patients as active partners in their care.

I’m too close to the event, too tired from a mental intensity which while invigorating, is fatiguing.  But, at the end of the day, it felt like this might be more than important, it might be the first step in a new part of our journey.  That will only occur if we don’t look at this as an interesting intellectual exercise in an isolated moment, with a nice “report” generated, but see it as the first step in a journey—with an unclear final destination, but a new set of needed partners who can support each of our paths in that effort.

Enough for now—it does look different from the outside……I’m polishing my new lens and reexamining the reality I thought I saw last week—with new eyes.

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