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Managing mental health: You might need training -- by an insurance company.

Primary care physicians increasingly are diagnosing and treating depression. Insurers are responding.

By Jonathan G. Bethely, amednews staff. Jan. 23, 2006.

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Even if you're not a psychiatrist -- especially if you're not -- you soon could be hearing from health plans about depression.

While employers and plans for years have developed disease management and behavioral health carve-outs that were supposed to manage mental illness costs, their efforts are getting more aggressive in the face of evidence that depression can exacerbate physical conditions, and vice versa, thereby costing employers and plans a lot of money.

Their efforts also are getting more aggressive in the face of evidence that in an overwhelming number of cases, it's a primary care physician who is diagnosing and treating depression.

So health plans are beefing up their disease management and behavioral health carve-outs, or even putting them together, as a means of coordinating care for depression. Plans are examining claims data, seeing if patients are following up a physician's recommended treatment. Plans also are combing through those data to identify patients who appear to have symptoms of depression but have not been diagnosed, and contacting primary care physicians to conduct a screening.

And at least one plan, Aetna, promises to pay extra for depression screenings, as long as doctors go through the plan's training program.

On one hand, primary care physicians are happy to see additional plan support and focus on depression. "It's a step in the right direction," said family physician Michael Klinkman, MD, who is director of primary care programs for the University of Michigan Depression Center in Ann Arbor and has studied how primary care physicians diagnose and treat depression.