Office of Rural Health and Primary Care - emergency models

Successful Model for Rural and Underserved Communities


Background: Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) is a promising effort to improve health care for people with depression because it changes the way care is delivered and how it is paid for.

Through the Institute for Clinical Systems Improvement, medical groups, health plans, employers and patients collaborated to develop an evidenced-based model for managing depression.

In the new reimbursement model, health plans make a monthly payment to participating medical groups for a bundle of services. Each medical group and health plan negotiates a care management fee, which may increase or decrease after 12 months depending on the medical group’s results with patients.

Description: DIAMOND helps primary care clinics be more proactive and effective in caring for adult patients with depression, using six tools:

  1. A standardized assessment questionnaire that helps the primary care provider detect and monitor the patient’s symptoms of depression
  2. A tracking system to help the primary care provider monitor the patient’s status
  3. A medical guide, backed by extensive clinical research, to help the primary care provider know how to best change or intensify treatment if needed
  4. Clinical care managers educate patients, and coordinate care with a consulting psychiatrist and primary care providers.
  5. A psychiatrist consults with the care team and provides additional assistance for patients with depression that is severe or not improving
  6. Tools to help the primary care provider prevent a patient who is getting from falling back into major depression.

Outcomes: Research has shown that this collaborative care approach results in improved outcomes, improved quality of life and greater productively and long-term health care cost savings for patients with depression.

Of patients contacted six months after being activated in DIAMOND, 43 percent were in remission. An additional 17 percent had seen at least a 50 percent reduction in the severity of their depression. These results are five to 10 times better than for patients with depression treated under “usual” primary care.

Partners: Minnesota medical groups and representatives from six of Minnesota’s commercial health plans and the Minnesota Department of Human Services. The roles of care manager and consulting psychiatrist were not reimbursable and therefore the care model was not sustainable under established payment systems. The partners helped develop the new payment system model to support DIAMOND.

Plans for the Future: HealthPartners Research Foundation, with a grant from the National Institute of Mental Health, is researching the effectiveness of the DIAMOND care model and reimbursement system. The study is looking at patient outcomes, as well as changes in patients’ work productively and use of health care services.

Contact: Nancy Jaeckels, vice president and chief consultant, ICSI Professional Partnerships at 952-814-7070 or

A printable version of this model (PDF: 35KB/2 pages)

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Updated Tuesday, November 12, 2013 at 02:09PM