Collaborative Care Cost-Sharing and Referral Rates in Colorado.

BACKGROUND: Collaborative care integrates mental health treatment into primary care and has been shown effective. Yet even in states where its use has been encouraged, take-up remains low and there are potential financial barriers to care. OBJECTIVE: Describe patient out-of-pocket costs and variations in referral patterns for collaborative care in Colorado. RESEARCH DESIGN: Retrospective observational study using administrative medical claims data to identify outpatient visits with collaborative care. For individuals with ≥1 visit, we measure spending and visits at the month level. Among physicians with billings for collaborative care, we measure prevalence of eligible patients with collaborative care utilization. SUBJECTS: Patients with Medicare, Medicare Advantage, or commercial health insurance in Colorado, 2018-2019. OUTCOMES: Out-of-pocket costs (enrollee payments to clinicians), total spending (insurer+enrollee payments to clinicians), percent of patients billed collaborative care. RESULTS: Median total spending (insurer+patient cost) was $48.32 (IQR: $41-$53). Median out-of-pocket cost per month in collaborative care was $8.35 per visit (IQR: $0-$10). Patients with commercial insurance paid the most per month (median: $15); patients with Medicare Advantage paid the least (median: $0). Among clinicians billing for collaborative care (n=193), a mean of 12 percent of eligible patients utilized collaborative care; family practice and advanced practice clinicians' patients utilized it most often. CONCLUSIONS: Collaborative care remains underused with fewer than 1 in 6 potentially eligible patients receiving care in this setting. Out-of-pocket costs varied, though were generally low; uncertainty about costs may contribute to low uptake.

Associations between racial and socioeconomic discrimination and risk behaviors among African-American adolescents and young adults: a latent class analysis.

PURPOSE: Discrimination is a common stressor among African Americans and may increase vulnerability to risk behaviors, such as early initiation of substance use, substance use problems, and physical aggression; however, few studies have examined different types of discrimination and their associations with patterns of risk behaviors. This study examines the relationship between experiences of racial and socioeconomic discrimination and risk behaviors in African-American adolescents and young adults. METHODS: We investigated associations of two discrimination types with risk behavior patterns identified with latent class analysis in a high-risk sample of African Americans (N = 797, Mage = 17.9 years, 50.2% female). RESULTS: Four distinct classes of risk behaviors were characterized by High Use and Aggression (10%), Moderate Use and Aggression (10%), High Alcohol (17%), and Low Use and Aggression (63%). Classes that exhibit general risk behaviors, including substance use and aggression, were significantly associated with racial and socioeconomic discrimination, even in the fully adjusted model. Relative to other classes, the High Use and Aggression class demonstrated an elevated likelihood of experiencing both racial and socioeconomic discrimination. CONCLUSIONS: Findings support a link between racial and socioeconomic discrimination and risk behavior in African-American youth, which may be stronger for socioeconomic discrimination. Understanding the relationship between discrimination and risk behavior can inform future interventions to prevent substance misuse and conduct problems in youth. Further study is needed to elucidate the relationship between discrimination and other risk behaviors.