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As an avid runner and diehard Red Sox fan, Brent P. Forester, MD, MSc, is no stranger to challenges. It was no surprise when he was asked, in 2015, to take on two taxing but critical roles—chief of the Division of Geriatric Psychiatry at McLean Hospital and medical director for Behavioral Health within Population Health Management at Partners HealthCare—that he eagerly said yes.
During his first day on the job at Partners, Forester was presented with his task: spearhead initiatives that are designed to provide better patient care and reduce medical costs.
“A significant health care challenge in our country now is something that Population Health Management directly addresses,” he said. “How should we identify and treat mental health problems in patients treated within primary care settings in a way that is both high-quality and cost-effective?”
At McLean, Forester is helping to address the mental health challenges of older adults who are living with mood disorders and other psychiatric illnesses, and also those with neurocognitive disorders, such as Alzheimer’s disease.
He pointed out that by the time many of these patients come to McLean, they are seeking second or third opinions. “We want to diagnose people earlier, not only to help identify and treat what is functionally impairing and adversely impacting quality of life, but what is also really ratcheting up overall health care costs.”
Forester’s work at McLean falls nicely in line with his new role at Partners HealthCare, where he is also leading a comprehensive clinical service program—a collaborative care model—to integrate behavioral health services into primary care across more than 190 member practice settings.
The goals of the behavioral health integration program at Partners include screening for depression at the primary care level and facilitating patient referrals to the appropriate resources.
“We’ve rolled out collaborative care to about 40 practices and we hope by the end of the year we’ll be in about one-third of all practices across the Partners network,” said Forester.
This venture gives clinicians in the mental health field an opportunity to both help design what behavioral health care should look like and work with colleagues in the primary care setting.
“For example, when you have a patient with diabetes or heart disease, the treatment is fairly straightforward and the outcomes are fairly predictable. Now, if that same patient also has depression, it gets more complex. The overall medical outcomes are worse, and because depression is more challenging to treat, the costs rise significantly,” explained Forester.
Added Forester, “by treating psychiatric illnesses when they occur in the context of patients’ medical problems, outcomes can improve.”