TY - JOUR
AU - K. Kim
AU - J. Zou
AU - B. Feng
AU - M. Luan
AU - A. Jones
AU - D. Gadbois
AU - J. Lim
AU - J. E. Schwartz
AU - Q. Chen
AU - N. Moise
A1 - 
AB - OBJECTIVE: This study aimed to determine predictors of long-term collaborative care reach and effectiveness. METHODS: The authors conducted a cross-sectional observational study of the New York State Collaborative Care Medicaid Program (CCMP). Subjects included clinics participating in CCMP from 2012 to 2019 with a ≥0.5 full-time-equivalent (FTE) care manager and data from 2021, 2022, or both. Main measures included clinic and fidelity characteristics. Outcomes were reach and effectiveness. Multilevel negative binomial regression models were used, with analyses adjusting for clustering by health care system and county. RESULTS: Of 157 eligible clinics, 71% were Federally Qualified Health Centers (FQHCs); the median caseload per care manager FTE was 55; reach, 13%; and effectiveness, 42%. In multivariable analyses, CCMP factors associated with reach included more engagement (adjusted rate ratio [aRR]=1.15), higher care manager FTE (aRR=1.06), larger caseload per care manager FTE (aRR=1.23), smaller clinic size (aRR=0.60), earlier adoption (aRR=0.40 in 2017-2019 vs. 2012-2014), and fewer academic or private clinics (vs. FQHCs) (aRR=0.66). Higher caseload per care manager FTE (aRR=1.05), more psychiatric consultations (aRR=1.04), greater early implementation effectiveness (aRR=1.07), and more FQHCs (aRR=1.15) were associated with greater effectiveness. CONCLUSIONS: Despite ongoing fiscal and technical assistance strategies, the CCMP struggles to achieve long-term reach. This study provides potential targets for optimizing implementation settings and pace of sustainability and is among the first to suggest a reciprocal relationship between effectiveness and reach and that an optimal caseload may promote both.
AD - Department of Medicine, Massachusetts General Hospital, Boston.; Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York.; New York State Office of Mental Health, Albany, NY.; Internal Medicine Residency Program, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York.; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York.; Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook, NY.; Center for Research on Cultural & Structural Equity in Behavioral Health, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY.
AN - 42159590
BT - Psychiatr Serv
C5 - Financing & Sustainability; Education & Workforce
CP - 8
DA - 08/2026
DO - 10.1176/appi.ps.20250212
DP - NLM
ET - 20260520
IS - 8
JF - Psychiatr Serv
LA - eng
N2 - OBJECTIVE: This study aimed to determine predictors of long-term collaborative care reach and effectiveness. METHODS: The authors conducted a cross-sectional observational study of the New York State Collaborative Care Medicaid Program (CCMP). Subjects included clinics participating in CCMP from 2012 to 2019 with a ≥0.5 full-time-equivalent (FTE) care manager and data from 2021, 2022, or both. Main measures included clinic and fidelity characteristics. Outcomes were reach and effectiveness. Multilevel negative binomial regression models were used, with analyses adjusting for clustering by health care system and county. RESULTS: Of 157 eligible clinics, 71% were Federally Qualified Health Centers (FQHCs); the median caseload per care manager FTE was 55; reach, 13%; and effectiveness, 42%. In multivariable analyses, CCMP factors associated with reach included more engagement (adjusted rate ratio [aRR]=1.15), higher care manager FTE (aRR=1.06), larger caseload per care manager FTE (aRR=1.23), smaller clinic size (aRR=0.60), earlier adoption (aRR=0.40 in 2017-2019 vs. 2012-2014), and fewer academic or private clinics (vs. FQHCs) (aRR=0.66). Higher caseload per care manager FTE (aRR=1.05), more psychiatric consultations (aRR=1.04), greater early implementation effectiveness (aRR=1.07), and more FQHCs (aRR=1.15) were associated with greater effectiveness. CONCLUSIONS: Despite ongoing fiscal and technical assistance strategies, the CCMP struggles to achieve long-term reach. This study provides potential targets for optimizing implementation settings and pace of sustainability and is among the first to suggest a reciprocal relationship between effectiveness and reach and that an optimal caseload may promote both.
PY - 2026
SN - 1075-2730
SP - 718
EP - 724+
ST - Predictors of Sustainability in the Collaborative Care Medicaid Program for Depression: A Cross-Sectional Study
T1 - Predictors of Sustainability in the Collaborative Care Medicaid Program for Depression: A Cross-Sectional Study
T2 - Psychiatr Serv
TI - Predictors of Sustainability in the Collaborative Care Medicaid Program for Depression: A Cross-Sectional Study
U1 - Financing & Sustainability; Education & Workforce
U3 - 10.1176/appi.ps.20250212
VL - 77
VO - 1075-2730
Y1 - 2026
ER -