Use of the Psychiatric Collaborative Care Model (CoCM) increased 26-fold nationally among commercially insured patients between 2018 and 2024, yet access to the evidence-based mental health care model remains highly uneven across states, according to a new analysis released today by Shatterproof and The Bowman Family Foundation.1
The “CoCM Progress Report” shows that national use of the CoCM grew from 12 to 317 patients per 100,000 individuals diagnosed with a mental health or substance use disorder during the 6-year period. However, state-level use varied dramatically.2 Arizona, Wisconsin, and Utah each reported more than 1000 CoCM patients per 100,000 eligible individuals, while many states—including Louisiana, Rhode Island, and Indiana—reported fewer than 50. Several states had almost no documented use.
Similar disparities were observed among Medicaid and Medicare populations. With few exceptions, states with high CoCM use among Medicaid patients also had high use across Medicare and commercial insurance, while states with low Medicaid adoption consistently lagged across all payer types.
CoCM is a team-based model that integrates behavioral health services into primary care settings, combining the expertise of primary care clinicians, behavioral health care managers, and psychiatric consultants. The approach emphasizes measurement-based care and treatment-to-target strategies, allowing primary care practices to manage common mental health and substance use conditions more effectively.
“CoCM efficiently integrates behavioral health services into primary care—where patients already seek help—doing so by increasing use of nonmedication therapies and assuring that only appropriate medications are prescribed at the lowest effective dose,” Henry Harbin, MD, advisor to The Bowman Family Foundation, said in the statement.1 “This model is a scalable solution to close critical gaps in behavioral health access.”
The report highlights a growing body of evidence showing that CoCM improves mental and physical health outcomes while reducing suicide risk, according to the statement. Multiple studies cited in the analysis also demonstrate cost savings for health systems and payers. Four studies involving Kaiser Permanente, Arkansas Blue Cross and Blue Shield, and Independence Blue Cross found reductions in total health care costs as early as 6 months after implementation, with savings sustained for up to 4 years.2
Despite these benefits, the authors identified reimbursement policy, particularly Medicaid reimbursement, as the primary driver of uneven adoption. The analysis concluded that when Medicaid programs do not reimburse for CoCM, providers in those states are far less likely to offer the model to any patients, regardless of insurance type.
Currently, Medicaid agencies and most Medicaid managed care organizations in 14 states provide little or no reimbursement for CoCM services, with limited exceptions for patients dually eligible for Medicare and Medicaid.
Kevin Roy, chief public policy officer at Shatterproof, said the findings reinforce the organization’s push to expand Medicaid coverage of CoCM, particularly as states face increasing budget pressures.1
“CoCM is a proven way to both improve patient outcomes and reduce overall costs for taxpayers—which is especially critical given the fiscal crisis states are facing with Medicaid cuts,” Roy said in the statement.
Roy also pointed to rapid growth in pediatric use of CoCM as a promising development. “We’re encouraged to see such expansion for children and adolescents, where early intervention matters most and offers a clear opportunity to address substance use gaps and save lives.”
In response to the findings, Shatterproof, The Bowman Family Foundation, and partner organizations are calling on states to adequately reimburse for CoCM and urging federal agencies, employers, commercial insurers, regulators, and providers to support broader adoption. The report outlines specific policy and operational steps aimed at reducing barriers to implementation and narrowing state-level disparities.2
As demand for mental health care continues to exceed supply, the authors argued that expanding CoCM reimbursement represents one of the most immediate, evidence-based opportunities to improve access, particularly through primary care, the most common point of contact with the health care system for many Americans.
References
Use of the Psychiatric Collaborative Care Model increases nationally, but large state disparities persist. News release. Shatterproof, Bowman Family Foundation. February 4, 2026. Accessed February 4, 2026. https://filesmhtari.org/Press_Release__CoCM_Progress_Report.pdfBowman Family Foundation. Mental Health Treatment and Research Institute (MHTARI). Progress report: psychiatric collaborative care model (CoCM). February 4, 2026. Accessed February 4, 2026. https://filesmhtari.org/COCM_Progress_Report.pdf