The use of collaborative care models has taken off in terms of utilization by providers and patients alike. 

A new study by Milliman details explosive early growth of the collaborative care model, an integration of behavioral health services into the primary care setting. 

Depending on how you slice it, the report shows massive growth increases — as high as factors of 22 times in the case of use in the commercial health plan population — over the space of five to six years. These kinds of growth multiples are reminiscent of the explosive growth some early-stage companies experienced in their early years. And just like in the world of startups, big-number growth tends to be a function of the newness rather than of market dominance.

Much of the growth of the collaborative care model is relatively isolated to specific geographies and within specific populations. Perhaps it’s not surprising that the collaborative care model, first enshrined in the language of health care billing codes by Medicare, is growing the fastest and has the greatest population reach within both Original Medicare and Medicare Advantage.

But also, like startups, the model’s early and rapid growth hints at its future potential. 

“I think [the report] does show that the model is sustainable financially,” Steve Biljan, chief commercial officer and co-founder of evolvedMD, told Behavioral Health Business. “There’s been a ton of clinical evidence for this forever. [The report] shows that you can deploy the model outside of a research setting.

Granted, Biljan and evolvedMD have something of a vested interest in the growth of the collaborative care model. The Scottsdale, Arizona-based evolvedMD-based company partners with physical health care organizations to implement the collaborative care model.

It provides the behavioral health providers and systems to support collaborative care models.

“If it wasn’t successful and had good patient and provider qualitative outcomes, it wouldn’t be expanding. … I do think it shows that there’s utility and that patients and providers presumably need the service or are utilizing it because it’s adding value,” Biljan continued.

The collaborative care model, developed by the University of Washington’s AIMS Center, features close collaboration between a behavioral health specialist and a primary care provider who collaborate closely on behavioral health needs.

A psychiatrist has less direct contact with patients and primary care providers and largely oversees patients systemically through case review. Generally, the model aims to address several problems with the extant bifurcation between behavioral and physical health. Two key challenges addressed are the shortage of providers and the need for a clear operating and reimbursement model to facilitate collaboration.

The new Milliman report was commissioned by the Dallas-based think tank The Meadows Mental Health Policy Institute. The institute did so on behalf of the nonprofit Path Forward, according to a news release from the organization. The American Psychiatric Association partnered with Path Forward, the release states.

“If every American suffering from depression had access to the collaborative care model, we estimate that approximately 14,000 lives could be saved each year from suicide,” Andy Keller, president and CEO of the Meadows Institute, said in the release. “[The model] is the gold standard for delivering mental health in primary care settings because mental health is, at its core, simply a very important part of health.

“This model is the single most impactful step we can take to get upstream, before tragedy strikes, to make Americans healthy again.”

What does the data show?

The study compiled and analyzed data sets that accounted for 219 million individuals, on average, for each year between 2018 and 2022 for Original Medicare, Medicare Advantage and Medicaid. The report includes the year 2023 for commercial health plan patients. The study does not compile the data into cross-population aggregates.

The largest increases in terms of health care providers engaging in collaborative care models, based on use of billing codes, was seen in providers caring for Medicare Advantage payments. Between 2018 and 2022, that number increased by a factor of 10 times.

The commercially insured population saw the largest growth in participation, increasing from 2018 to 2022 by a factor of 16.6 times and 22.2 times by 2023.

In terms of raw numbers, about 5,700 distinct providers billed Medicare Advantage plans, 5,400 billed Medicaid, 5,100 billed Original Medicaid and 3,700 billed commercial plans in 2022. That number in 2023 was 5,000 for commercial health plans. Again, 2023 data were not in the report for the public health plans.

What’s behind the growth?

One key to the model’s growth is the development of tracking and billing codes that track its various components. This enabled a shared language between providers and payers who were looking for ways to integrate care.

Billing codes alone don’t guarantee the adoption of a model of care. (Consider prescription digital therapeutics, for example.) Rather, several interrelated factors have pushed the growth of collaborative care models to this point.

“This is a confluence of both society and the health care industry recognizing how critical this is; mental health is now out of the shadows,” Concert Health CEO Spencer Hutchins told BHB. “People are comfortable and willing to talk about it. They also have higher expectations.”

Another key aspect was being able to be compensated for the collaborative nature of care in this model. In 2017, Medicare began payments for the codes related to the model. With a path forward financially, early physical health adopters jumped into the model with aplomb.

Concert Health also partners with physical health providers to establish collaborative care models. It now operates partnerships with “dozens” of large health systems, Hutchins said. It employs about 400 people and operates in 14 states.

Both Concert Health and evolvedMD have also experienced success in business terms with this model. Concert Health raised $42 million in 2022. Last year, evoledMD was recognized as one of the fastest-growing companies in the U.S., growing revenue by 255% in the three-year period ending in 2023.

evolvedMD operates in five states and employs about 110 people. Biljan said the company doubled revenue year-over-year in 2024 and expects the company to make the Inc. 5000 again.

Geographic concentration 

Arizona stands out in the data. The state and its specific metros studied in the report lead or are among the leaders in all measures of growth and adoption. Wisconsin and Minnesota similarly are among the leading states across several measures.

“Utilization is probably being driven by pockets of champions. I think that story rings true, considering the maps for evolvedMD, where we are or were located at the time,” Biljan said. “Other markets are dependent on, probably, a health system doing something kind of at scale … The adoption is good, but I think it could be a heck of a lot better.”

Biljan isn’t shy about claiming some credit for the growth of the collaborative care model in Arizona, his home state; he was “really proud to see the one state that’s head and shoulders” above the rest in every payer category.

Key hurdles to adoption include startup costs and the general difficulty of instituting clinical and operational changes across and among providers of differing types. Moreover, the time commitment to plan and execute models may dissuade providers from engaging in the model.

Further development of the model from the payer/financial perspective could accelerate adoption for other providers. Presently, another barrier to adoption is getting enough of a physical health provider’s payers to get on board with a collaborative care model to make it worth it from an operational perspective. Having too small of a population under the model calls into question if it would be worth the effort to do something different than is required with other payer contracts, Hutchins said.

“I think this study and our experience show that the economics have to work, and it has to work for a primary care provider’s entire panel … in order to really get traction,” Hutchins said.