Resource library

A directory of Collaborative Care Service Organizations (CSOs) which provide CoCM implementation support and/or staff to health systems and primary care practices.

Four CoCM Studies — each involving Kaiser Permanente, Arkansas Blue Cross and Blue Shield, or Independence Blue Cross — demonstrated reductions in Total Healthcare Costs, as soon as within 6 months and for as long as 4 years.

Integrated Behavioral Health Care (IBHC) continues to grow as an evidence-based service delivery model adopted by health care systems all over the world to better care for the holistic needs of patients and their families. Medical Family Therapy (MedFT) has offered innovation to IBHC models by delivering biopsychosocial-spiritual (BPS-S), relational, and family-oriented care across a variety of healthcare contexts. This article details a longitudinal review of a program spanning 16 years that grew to a highly integrated operation that embeds MedFTs in a number of rural community health centers. This model highlights the importance of interdisciplinary teams and decision-making metrics for systems that predominately care for underserved and minoritized populations.

The Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study was a landmark trial that examined the IMPACT collaborative care management program for older adults with depression through a randomized control study. Results suggest that the model is feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

This report describes the early use of the Collaborative Care Model (CoCM) and general Behavioral Health Integration (BHI) billing codes among clinicians. Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017–2018. This study of codes designed to promote BHI reveales an eightfold increase in CoCM and general BHI use between 2017 and 2018. However, denied services represent a barrier and use among eligible beneficiaries remains low.

Novel Current Procedural Terminology (CPT) codes specific to the Collaborative Care Model (CoCM) offer advantages to traditional billing options, although their implementation may require considerable billing and clinical workflow adjustments. This research article presents a case study addressing the challenges of using these codes within the University of Washington Neighborhood Clinics (UWNC), an academically affiliated primary care clinic system in western Washington State.

This report analyzes the impact of Collaborative Care adoption since CMS recognized dedicated billing codes, and provides details on the volume of services, patients, and providers using CoCM using health care claims and CMS insurance databases.

This report analyzes national patterns of CoCM billing in commercial insurance plans, Medicaid, and Medicare, offers insights based on billing data, comments from providers, and prior studies, and recommends specific steps to expand CoCM billing in all states.

This resource list relates to the Psychiatric Collaborative Care Model ("CoCM"), the gold-standard approach to improving mental health and substance use clinical outcomes when care is provided in primary care settings — where most people receive their mental health and substance use care.

The Collaborative Care Model (CoCM) is an effective strategy to manage common mental disorders in primary care. Despite the growing adoption of newer CoCM billing codes to support these programs, few studies have investigated the use of these codes. This research article evaluates the implementation of CoCM billing codes by comparing clinics using different billing strategies and assesses the impact of CoCM code implementation on revenue and clinical and process-of-care outcomes.

This interactive toolkit was developed to help primary care providers and practices build and maintain financially sustainable integrated behavioral health (IBH) models. It establishes a shared definition of value for IBH and highlights the cultural shifts and core operations needed to maximize it. It outlines the funding streams available for behavioral health integration and how to navigate the transition from volume- to value-based payment. The toolkit also provides tools and benchmarks for calculating start-up and implementation costs, potential offsets and savings, and revenue, and offers financing considerations and strategies tailored by payer, setting, and patient population.

Strengthen your care team’s ability to deliver high-quality collaborative care with expert-led, self-paced online training focused on integrating behavioral health into primary care. The Collaborative Care Training Hub is a partnership between Meadows Mental Health Policy Institute, West Health Institute, and Northwestern Medicine, developed as part of the Northwestern Medicine West Health Accelerator. It combines case-based learning, hands-on workflows, and implementation tools to build skills, confidence, and clinical capacity.

An essential part of the Collaborative Care workflow is the use of a registry to manage caseloads and track patient outcomes. An effective registry must track clinical outcomes and progress at both the patient and target population caseload levels, facilitate treatment-to-target by summarizing patient’s progress in an understandable and actionable way, and enable efficient psychiatric consultation and Systematic Caseload Review, allowing providers to easily prioritize patients who need evaluation for changes in treatment or who are new to the caseload.

Collaborative Care requires a team of professionals with complementary skills who work together to care for a population of patients with mental conditions such as depression, anxiety, PTSD, etc. It involves a shift in how medicine is practiced, the creation of entirely new workflows, and frequently the addition of new team members.

As you plan for behavioral health integration, consider all the benefits of providing effective, evidence-based behavioral health care. There are many critical factors that play a role in helping a practice develop a comprehensive sustainment plan. Finances are just one aspect to consider.

A substantial body of evidence for Collaborative Care has emerged since its development at the University of Washington in the 1990s. Beginning with the seminal IMPACT Trial published in 2002, more than 90 randomized controlled trials and several meta-analyses have shown the Collaborative Care model (CoCM) to be more effective than usual care for patients with depression, anxiety, and other behavioral health conditions. CoCM is also shown to be highly effective in treating co-morbid mental health and physical conditions such as cancer, diabetes, and HIV.

This guide is for multi-disciplinary, primary care teams seeking to improve care access and behavioral health outcomes for children and adolescents through implementing Collaborative Care. Centered around the core principles of Collaborative Care, this guide serves as a roadmap to healthcare leaders, managers, clinicians, and staff in primary care as they start a new Collaborative Care program, expand an existing integrated care or Collaborative Care program to pediatrics, or partner with community and behavioral health agencies.

This guide is for multi-disciplinary, primary care teams seeking to improve care access and behavioral health outcomes for their patients through implementing Collaborative Care. Centered around the core principles of Collaborative Care, this guide serves as a roadmap to health care leaders, managers, clinicians, and staff in primary care as they start a new Collaborative Care program, or partner with community and behavioral health agencies.

Tracking metrics is essential for understanding how your CoCM program is performing, in terms of program process and clinical patient outcomes. Metrics help identify areas for improvement, support continuous quality improvement efforts, and provide a clear picture of progress over time.

An overview of CoCM billing codes, including time thresholds, patient cost-sharing, and claim submission requirements.

Guidance on establishing and using a CoCM registry, including key functions and a decision matrix to help health systems and clinical teams decide which type of registry to use.

This document outlines an initial framework developed by national experts and includes evidence-based practices for screening, differential diagnosis, and symptom monitoring for patients aged 6 to 11 within pediatric primary care.

An overview of the extended multidisciplinary transformation team that works together at every level of the organization to plan, build, and maintain CoCM.

CoCM is extensively evidence-based, with its efficacy being demonstrated by more than 90 randomized controlled trials and several meta-analyses across diverse diagnoses (e.g., depression, anxiety, bipolar disorder), patient populations, and treatment settings.

A comprehensive checklist outlining key considerations, essential steps, and program requirements to implement a full-fidelity Collaborative Care program.

Clinical workflow details to support the implementation of CoCM for adults. This document illustrates how an adult patient is referred to the CoCM team.

An overview of the CoCM clinical team structure, explaining each team member’s distinct role in CoCM, with key clinical, administrative, and billing responsibilities.

Through universal screenings for mental health conditions in primary care, integrated care can lead to earlier identification of, and intervention for, mental health and substance use conditions.