Collaborative Care Cost-Sharing and Referral Rates in Colorado

Abstract

Background: Collaborative care integrates mental health treatment into primary care and has been shown effective. Yet even in states where its use has been encouraged, take-up remains low and there are potential financial barriers to care.

Objective: Describe patient out-of-pocket costs and variations in referral patterns for collaborative care in Colorado.

Research design: Retrospective observational study using administrative medical claims data to identify outpatient visits with collaborative care. For individuals with ≥1 visit, we measure spending and visits at the month level. Among physicians with billings for collaborative care, we measure prevalence of eligible patients with collaborative care utilization.

Subjects: Patients with Medicare, Medicare Advantage, or commercial health insurance in Colorado, 2018-2019.

Outcomes: Out-of-pocket costs (enrollee payments to clinicians), total spending (insurer+enrollee payments to clinicians), percent of patients billed collaborative care.

Results: Median total spending (insurer+patient cost) was $48.32 (IQR: $41-$53). Median out-of-pocket cost per month in collaborative care was $8.35 per visit (IQR: $0-$10). Patients with commercial insurance paid the most per month (median: $15); patients with Medicare Advantage paid the least (median: $0). Among clinicians billing for collaborative care (n=193), a mean of 12 percent of eligible patients utilized collaborative care; family practice and advanced practice clinicians' patients utilized it most often.

Conclusions: Collaborative care remains underused with fewer than 1 in 6 potentially eligible patients receiving care in this setting. Out-of-pocket costs varied, though were generally low; uncertainty about costs may contribute to low uptake.