Colorado’s Medicaid program has taken a significant step in addressing mental health care by allowing reimbursement for collaborative treatment efforts within primary care settings. Effective from July 1, 2023, this initiative aims to integrate mental health services directly into primary care practices, facilitating better access to support for individuals with mental health conditions and addictions.
The collaborative care model permits mental health professionals to work alongside primary care providers. Psychiatrists will be available to consult on patient needs, often utilizing telehealth for convenience. This model is a shift in the Medicaid payment structure, as it traditionally focused solely on direct treatment costs, not on the crucial behind-the-scenes work of care coordination.
According to Path Forward, a nonprofit organization advocating for collaborative care, Colorado becomes the 36th state to implement this coverage. The Colorado Department of Health Care Policy and Financing estimates that the initiative will initially cost the state’s general fund approximately $368,000, supplemented by around $1.1 million in federal matching funds.
Dr. Shen Nagel, affiliated with Pediatrics West in Wheat Ridge, expressed optimism about the new billing allowance. Previously, primary care providers had to refer patients to external mental health professionals, hoping they would seek the needed care. With an on-staff mental health provider, patients can receive assistance directly within a familiar environment, enhancing the overall treatment experience.
While the collaborative care model does not eliminate the need for referrals entirely, it allows some patients to access care where they feel most at ease. Dr. Nagel noted that their practice could easily fill the schedules of five to six behavioral health providers, indicating a significant demand for such services.
Despite the promise of this model, its adoption has been limited in Colorado. A report by the consulting firm Milliman shows that only about 500 individuals received collaborative care under commercial insurance in 2023, while 700 were covered under Medicare in 2022. Nationally, approximately 125,000 individuals benefited from collaborative care funded by private insurance, with an additional 73,000 under Medicare or Medicaid.
Research has shown that patients with depression who engage in collaborative care often report greater improvements compared to those receiving standard primary care. Although outcomes can vary widely, some clinics report that one-third of their patients experience reduced symptoms, while others, such as a facility in Texas, noted that up to four out of five patients improved at least partially.
Dr. K. Ron-Li Liaw, chief of mental health at Children’s Hospital Colorado, highlighted the importance of this development, particularly for pediatric patients. She pointed out that while most providers using the collaborative care model focus on adults, Colorado has a unique opportunity to cater to the roughly 20% of pediatric patients who have behavioral health needs. A psychiatrist at Children’s Hospital will collaborate with six practices, including Pediatrics West, to explore effective implementation strategies for children.
As Colorado moves forward with this initiative, the mental health provider community is watching closely, especially given the state’s anticipated budget gap next year. The successful integration of mental health services into primary care may set a precedent for other states, demonstrating the benefits of accessible mental health support.
This new approach not only aims to improve patient outcomes but also seeks to create a more sustainable model for primary care practices, ultimately enhancing the overall quality of health care in Colorado.