Table 3.

Models to Improve Health and Health Care for People with Serious Mental Illness

Model	Description	Limitations	Setting	Clinician Involvement
Dually trained physicians^48,49,57	Physician trained in both psychiatric and physical medicine manages all care	Few available, may not maintain sufficient skills for complex medical care, may not be optimal use of resources	High concentration of medical comorbidity, eg, inpatient and chemical-dependency treatment centers	High
Physical medicine on-site consultation^41,50	Physical medicine clinician provides consultation and care within psychiatric clinic or inpatient setting	Expensive unless volume is sufficient to fill consultant's schedule	Concentrated medical comorbidity, eg, inpatient and addiction centers or as outreach model for large clinics managing many SMI patients seen in limited number of psychiatric clinics	High
Collaborative care^45,51,52	Frequent communication between mental and physical health care teams	Requires un-reimbursed communication time, added attention to HIPAA compliance, and supportive communication infrastructure (eg, secure e-mail, telephone access, medical record access)	Financially and administratively integrated systems with shared medical records, eg, HMOs and VA, co-located clinics	Intermediate
Case manager^53,54	Often a registered nurse who coordinates transportation and appointments, monitors health status and treatment adherence	Time intensive for nurse, potentially expensive	Any setting with sufficient volume of patients	Low
Facilitated referral to primary care^55,56	Psychiatric care team facilitates access to primary care team	Requires sufficient primary care access in community	Private clinics, geographically dispersed practice locations	Intermediate

SMI, serious mental illness; HIPAA, Health Insurance Portability and Accountability Act; HMO, health maintenance organization; VA, Veteran's Association.
Adapted and expanded from framework of Druss and Bower.^50,58