Launching Collaborative Care Management (CoCM) is a significant investment, both financially and operationally. For practices building in-house, implementation costs typically run around $200,000 per clinic, covering everything from recruiting specialized staff to training teams and licensing necessary software. But the commitment doesn't end after launch. Practices often find that maintaining the right balance of resources, caseloads, and workflows over time is what determines whether a program thrives or struggles.

Many practice leaders believe that once their program is up and running, sustainability will come naturally. The truth? It takes ongoing effort and precise management to keep the balance between quality care and financial health.

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Why Ongoing Costs Matter

Even after hiring and training skilled care managers, costs continue. Regular psychiatric consultation, up-to-date registry systems, patient engagement tools, and seamless integration with existing EHR systems all require time, attention, and resources. Specialty software alone can cost thousands of dollars annually in licensing fees, while ensuring consistent psychiatric availability for weekly caseload reviews requires careful relationship management and appropriate compensation structures.

These operational elements don't reflect a flaw in the model, they're essential components of delivering high-quality care consistently. Quality assurance, ongoing supervision, and program fidelity all require dedicated expertise that many practices underestimate when budgeting for the long term.

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The Critical Numbers: Finding the Sweet Spot in Caseloads

Here's where many programs face their biggest sustainability challenge: each behavioral health care manager needs to maintain a caseload of at least 60 active patients per month to deliver positive net margins.

When utilization falls below 50 patients per care manager, your program operates at a loss. The care manager's salary, benefits, and overhead costs remain constant, but your revenue doesn't.

This isn't a theoretical concern. Caseload management proves difficult at the practice level because of:

• Ramp-up time: Building a full caseload takes months, during which you're paying full costs for partial revenue
• Patient turnover: As patients complete treatment successfully, maintaining a full panel requires constant new referrals
• Seasonal fluctuations: Referral patterns vary throughout the year
• Staff turnover: When a care manager leaves, you lose not just the position but the entire caseload, creating immediate financial impact
• Limited economies of scale: A single practice doesn't have enough volume to smooth out these variations

Successful programs actively monitor caseloads and adjust for patient complexity and contact frequency. The goal is to maintain enough patients to spread costs efficiently while preserving the personalized care that makes CoCM effective. But achieving this balance consistently is one of the most common reasons programs fail to meet their financial goals.

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Common Operational Hurdles

Beyond caseload management, practices encounter challenges like:

• Recruitment and retention: Finding master's-level behavioral health professionals with collaborative care expertise in a tight labor market
• Psychiatric consultant availability: Securing psychiatrists willing to work in consulting roles and ensuring their consistent engagement
• Documentation delays: Missing billing opportunities due to incomplete or delayed documentation
• Patient enrollment infrastructure: Building the screening protocols, referral workflows, and outreach systems needed to consistently fill caseloads
• Quality oversight: Maintaining fidelity to the evidence-based model while managing day-to-day operations

These issues aren't a reflection of the Collaborative Care model itself. They're operational realities that, when managed well, can be anticipated and resolved. However, they require specialized expertise that most primary care practices don't have in-house.

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How Turnkey Models Remove Implementation Barriers and Utilization Risk

A trusted turnkey partner fundamentally changes the economics and operational burden of CoCM. Rather than absorbing the $200,000 in implementation costs and ongoing utilization risk, practices can deliver collaborative care without the financial uncertainty.

Here's what the turnkey model provides:

Eliminates upfront investment in recruiting, training, software licensing, and program development

Removes utilization risk by making every patient referral profitable, whether you refer 5 patients or 50

Provides immediate access to pre-trained care managers with years of collaborative care experience

Delivers established psychiatric consultation through a ready network of consulting psychiatrists

Includes proven technology with registry and patient engagement tools already built and maintained

Ensures ongoing quality assurance backed by years of program experience and continuous improvement

Integrates seamlessly with your existing EHR workflow, requiring no new platforms for your providers to learn

Perhaps most importantly, turnkey partners can absorb utilization risk through scale across multiple practices, fine-tuned workflows developed over thousands of patient encounters, experienced team management that maximizes efficiency, and technology-enabled care delivery that extends each care manager's reach.

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Making the Build vs. Partner Decision

The choice to build CoCM in-house or partner with a turnkey provider comes down to a few key questions:

• Do you have $200,000+ in startup capital and patience for a 6-12 month ramp-up period?
• Can you recruit and retain specialized behavioral health talent in your market?
• Do you have the volume to sustain 60+ patients per care manager consistently?
• Do you have existing CoCM expertise to train your team and ensure program quality?
• Are you willing to absorb the financial risk of underutilization, especially in the first year?

For most primary care practices, the answer to several of these questions is "no" and that's perfectly reasonable. Building complex new service lines isn't what most practices are set up to do, especially when their focus should be on delivering excellent patient care.

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An Investment Worth Making

CoCM requires resources, patience, and attention to detail. When a program balances staffing, caseloads, and workflows effectively—whether built in-house or delivered through a turnkey partner—it delivers lasting value: better patient outcomes, stronger provider support, and a sustainable program that grows stronger over time.

The evidence for collaborative care is clear: across more than 90 randomized controlled trials, CoCM has been shown to improve depression and anxiety outcomes while lowering total cost of care. The question isn't whether CoCM is worth doing—it's how to implement it in a way that's realistic for your practice's resources, timeline, and risk tolerance.

Want to learn more about delivering collaborative care without the implementation costs and utilization risk? Download our Collaborative Care Buyer's Guide for a detailed comparison of in-house vs. outsourced CoCM.

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