Across all payer types, the number of clinical professionals delivering integrated, mental health and primary care services using the Collaborative Care Model (CoCM) billing codes increased by at least a factor of five nationally between 2018 and 2022, according to a recent study. Adoption rates varied considerably between insurance coverage types and across different geographic regions of the U.S., the researchers reported. While coverage of CoCM is universal for Medicare beneficiaries, and common for those with commercial insurance, less than half of U.S. states have activated CoCM codes in their Medicaid and CHIP programs, the report stated.
From 2018 to 2022 (or 2023 for the commercial market), the number of distinct clinical professionals billing for CoCM services increased each year for each insurance coverage type. The number of participating clinical professionals was initially highest for Original Medicare (at 881), but by 2022, it was highest for Medicare Advantage (at 5,660).
Adoption of CoCM is generally lower in rural areas for all insurance coverage types, the report stated. Across all measures studied, the level of adoption in Medicaid and the Children’s Health Insurance Program (CHIP) is notably higher in states that have activated CoCM codes for their Medicaid plans compared to states that have not. These gaps indicate that there may still be many opportunities to increase the reach of this model if appropriate measures, such as state adoption of CoCM codes, which appears to significantly boost adoption of CoCM, are taken to encourage and support its adoption, the researchers concluded.
While the adoption of the CoCM has expanded across all four major insurance coverage types since 2018, in terms of the number of participating professionals, consumers served, and the volume of services provided, according to the researchers, much of the growth was driven by a small number of metropolitan statistical areas with higher-than-average adoption rates. There are significant differences between geographic areas, and some have not had any meaningful adoption of the CoCM.
Across 387 metropolitan statistical areas (MSAs) located across all 50 states, payer participation in CoCM was highest for commercial insurers and lowest for original Medicare, based on the number of MSAs without any claims for CoCM, and the number of states without CoCM claims for non-metropolitan areas, as follows:
- For commercial insurers, 32 of the 387 MSAs had no CoCM claims. There were no CoCM claims from the non-metropolitan areas of one state.
- For Medicaid and CHIP, 120 of the 387 MSAs had no claims. There were no CoCM claims from the non-metropolitan areas of eight states.
- For Medicare Advantage, 171 of the 387 MSAs had no claims. There were no CoCM claims from the non-metropolitan areas of 14 states.
- For Original Medicare, 200 of the 387 MSAs had no claims. There were no CoCM claims from the non-metropolitan areas of 18 states.
At the state level, adoption of CoCM varied significantly across the U.S. In 2022 (or 2023 for the commercial market), the regional variation included the following:
- Arizona had consistently high adoption rates of CoCM, measured by the proportion of the population that has received CoCM services, across all studied insurance coverage types.
- The Great Lakes region was a hot spot for all studied insurance coverage types. Minnesota, Wisconsin, and Michigan all have relatively high adoption rates for Original Medicare and Medicare Advantage and to a lesser extent for Medicaid and CHIP. For the commercial market, Wisconsin stands out above the rest.
- In the Pacific Northwest, adoption in Oregon is lower for Medicare Advantage and the commercial market
- Adoption in Wyoming is elevated for Medicare Advantage. Adoption in Colorado is low for Medicaid and CHIP. Adoption is low in Idaho across the board.
- Most of the Great Plains states, the Midwest (outside of the Great Lakes region), and the South have relatively low adoption rates across all insurance coverage types studied.
The CoCM involves a primary care or specialty care professional, a behavioral health care manager, and a psychiatric consultant using a structured, measurement-based framework. Medicare billing codes for CoCM were first available in 2018. After Medicare began reimbursing for CoCM, commercial payers began reimbursing for collaborative care services.
Payers reimbursing for CoCM codes are in all states, but consumer access to CoCM remains limited. In 2023, commercial payers paid reimbursement for CoCM claims submitted for care delivered to 100,000 people with mild to moderate mental illness. These individuals who received CoCM services represented 1% or less of the nearly 60 million adults and children with mild and moderate mental illness who could benefit.
The adoption of the CoCM as of 2022 was highest in Medicare Advantage in terms of both the number of members per 100,000 population who received CoCM and the number of CoCM service units billed per 100,000 population. The lowest adoption rate was in Medicaid and CHIP.
These findings were reported in Trends In Adoption Of The Collaborative Care Model: Analysis Of Variation By Payer And Region, 2018–2023 by Stoddard Davenport, MPH; Michael Mager, ASA, MAAA; and Bridget Darby, MS, with Milliman. The research was commissioned by the Meadows Mental Health Policy Institute, on behalf of Path Forward. The researchers analyzed five years of claims data for 219 million people spanning 2018 to 2022 for Medicare and Medicaid (including managed care plans and fee-for-service). For those covered by commercial health plans, the data set spans 2018 through 2023.
The full text of Trends In Adoption Of The Collaborative Care Model: Analysis Of Variation By Payer And Region, 2018–2023 was published on May 20, 2025, by Path Forward. A free copy is available online at https://pathforwardcoalition.org/wp-content/uploads/2025/05/Milliman-Collaborative-Care-report-2025-05-13.pdf (accessed May 29, 2025).
For more information, contact: Juliana Keeping, External Relations Director, Path Forward Coalition, 224 West 35th Street, Suite 500-1117, New York, New York 10001; 405-570-0734; Email: juliana@pathforwardcoalition.org; Website: https://pathforwardcoalition.org/
August 2025 00US25EUA0023