Collaborative Care Cost-Sharing and Referral Rates in Colorado.

backgroundCollaborative 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.

objectiveDescribe patient out-of-pocket costs and variations in referral patterns for collaborative care in Colorado. RESEARCH

designRetrospective 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.

resultsMedian 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.

conclusionsCollaborative 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.