Real-world implementation of Collaborative Care in the United States: a systematic review

The demand for behavioral health services continues to outpace the supply of the behavioral health workforce, resulting in many people seeking behavioral health services within their primary care practice. Collaborative Care is an effective, evidence-based model of behavioral health service integration into primary care. An extensive literature of randomized controlled trials exists, with much less published about the outcomes of Collaborative Care in real-world settings. This systematic review aims to describe and summarize results of the published literature regarding real-world implementation efforts of CoCM and suggests a reporting framework for future implementation efforts to better understand, compare, and evaluate CoCM programs.

We searched articles in PubMed and Web of Science published between Jan 1st 2000-September 30th 2024. Eligibility criteria included the following: (1) conducted in the United States, (2) real-world implementation studies, (3) adult patient population, (4) demonstrated the main elements that define CoCM as outlined by Medicare, (5) information above was publicly available in the article or supplementary material. The definition of CoCM was selected based on major professional organizations and Center for Medicaid/Medicare Services (CMS) criteria for Collaborative Care billing codes.

A total of 21 articles were included in this review. Overall, Collaborative Care programs were found to be clinically effective across a wide range of settings and populations. The most common clinical outcomes reported were depression response (a 50% reduction in PHQ-9 score or a PHQ-9 score less than 10) and remission (PHQ-9 score less than 5). Depression response ranged from 30% to 58%. Remission ranged from 19% to 54%. Process measures were reported inconsistently. This suggests the potential utility of a reporting checklist for integrated care implementation.

This review adds to a growing literature capturing Collaborative Care effectiveness and feasibility in real-world settings. More consistent reporting of Collaborative Care model components and process measures in the Collaborative Care literature is needed.