Scaling Collaborative Care to 75 Clinics: What Northwestern Medicine Learned About Adoption, Access and “Fast Track” Referrals

Lisa Rosenthal, MD, medical director and principal investigator of the Northwestern Medicine West Health Accelerator, recently presented at the Collaborative Care Model Joint Residency Training co-hosted by West Health and the American Psychiatric Association, alongside the AIMS Center, Meadows Mental Health Policy Institute and Northwestern Medicine.

Drawing on the experience of Northwestern Medicine in scaling the collaborative care model (CoCM) across 75 primary care clinics, Dr. Rosenthal shared what it takes to expand access to and equity in mental health care at scale, as well as what health systems might underestimate along the way.

Recognizing the need for a different approach

By the time Dr. Rosenthal discovered the collaborative care model, she had already spent years as a consultation-liaison psychiatrist after working in community mental health early in her career. (Colleagues at the Academy of Consultation Liaison Psychiatry presented early data from the AIMS Center on CoCM.)

She recognized the gaps and stigma that impact psychiatric care for patients and health systems. Individual specialty care referrals to psychiatry, while essential, were not able to keep up with demand, were not equitable and psychiatry was not recognized as a value-added opportunity for health systems.

CoCM reframed the work entirely.

Instead of waiting for referrals or patient self-advocacy, it offered psychiatry a way to reach people at scale within primary care through population-based screening. Equity, Dr. Rosenthal said, becomes operational when everyone is screened, not just the patients who know how or feel safe enough to ask for help.

“When I heard about collaborative care, the idea of being effective for populations was mind-blowing and a game-changer for me personally and for psychiatry in general,” she says.

Piloting CoCM at Northwestern Medicine

Turning that insight into practice took time. Dr. Rosenthal spent several years advocating for what would be the first collaborative care pilot at Northwestern Medicine. Early proposals were impacted by confusion about psychiatry and the model and by lack of reimbursement options, but she remained convinced the model could expand access to behavioral health care for patients who needed it most.

In 2016, the program finally received funding from Northwestern Medicine. The pilot was deliberately scrappy: an Excel spreadsheet registry, one behavioral health care manager and a small allocation of psychiatrist time — but it worked.

The first-ever behavioral care coordinator at Northwestern Medicine, Garrett Raubolt, and consulting psychiatrist, Jeffrey Rado, MD, were the clinicians who made the pilot work.

“We got great feedback on our pilot, including satisfaction from the PCPs, which was really important,” Dr. Rosenthal says.

That early success helped the team secure grant funding for research and support from Northwestern Medicine to expand the program to 13 clinics as Medicare approved CoCM funding, but it also revealed new challenges as the program grew.

Barriers to patient enrollment in CoCM

As the program scaled, the team noticed a disconnect: Patient eligibility didn’t guarantee enrollment.

To better understand why, they surveyed 80 patients who had been referred to the program but never enrolled. The most common barrier wasn’t clinical — it was confusion. Many patients assumed collaborative care meant medication only, not realizing psychotherapy, behavioral activation and care management were central components of treatment.

Cost anxiety was another common concern.

The insight prompted the team to more clearly communicate that collaborative care visits typically cost the same as a primary care copay. Today, Dr. Rosenthal notes, most patients enrolled in the program pay less than $50 a month for collaborative care services.

Making the right thing the easy thing

Around the same time, Medicare introduced required depression screenings, raising an important operational question: What happens after a patient screens positive?

“In quality improvement, there is an important tenet that if you want people and systems to do something, you have to make it the easiest thing to do. But for psychiatry, doing the right thing has usually been the hardest,” she says. “That’s what our Accelerator aims to address, because integrating psychiatry should not just be right, it should be easy.”

That gap between intention and execution became a central focus of the program.

Scaling CoCM through the Accelerator

In early 2024, West Health and the Meadows Mental Health Policy Institute approached Northwestern Medicine about formalizing and accelerating its collaborative care efforts. The partnership led to the launch of the Northwestern Medicine West Health Accelerator.

The Accelerator had an ambitious mandate: make best practices common, faster than traditional health system change typically allows.

That meant building population health programs that were replicable and financially sustainable, embedding data and evaluation into implementation, and strengthening collaboration across primary care, psychiatry and community partners.

By mid-2024, Northwestern Medicine expanded its Collaborative Behavioral Health Program (CBHP) to all primary care sites across the Chicago area.

What the team hadn’t done enough of, Dr. Rosenthal candidly shared, was conducting needs assessments, providing education and setting expectations. While clinics were screening patients for depression and anxiety, referrals to collaborative care remained slow.

Increasing referrals through the fast track program

To address the referral bottleneck, the team redesigned the process.

In addition to the traditional CoCM workflow — where primary care clinicians screen patients using the PHQ-9 and GAD-7 — the team introduced a new pathway inspired by a model developed at the University of Pennsylvania. The Accelerator called it the “Fast Track” referral pathway.

With Fast Track, primary care physicians can refer any patient at any time, for any reason, without requiring upfront screening. They continue to encourage population screening and will also accept any patient at any time for any psychiatric reason except for urgent symptoms.

After clinician consent, patients complete digital screening. If the results fall within CoCM parameters (such as anxiety or depression without severe psychosis or active addiction), they are automatically referred to collaborative care.

If the digital screening results were unclear or their screening was incomplete, patients receive a brief visit with a social worker, who could either refer them back to collaborative care or make two attempts to connect them with another appropriate resource, such as specialty care, support groups or financial counseling.

The impact was immediate: Early data showed a roughly 253% increase in referral volume, alongside the program's progress toward operational near-break-even.

“If you build it, they may not come, but if you make it less of a burden to screen and refer, they may be more likely to,” said Dr. Rosenthal.

Reinforcing adoption at the clinic level

Fast Track wasn’t the only change. Based on primary care feedback, CBHP leaders lowered the PHQ-9 and GAD-7 score thresholds from 10 to 5, introduced physician champions and made referrals a visible key performance indicator (KPI) on clinic dashboards. The team also implemented peer-led audit-and-feedback models to reinforce engagement and normalize collaborative care in routine practice.

Together, those interventions helped shift collaborative care from a novel option to an expected workflow.

A cultural shift, not just a scaled program

While the collaborative care footprint at Northwestern Medicine now spans 75 primary care clinics, for Dr. Rosenthal, the real achievement is the cultural change behind them. Psychiatry is no longer an add-on or an afterthought. It’s embedded into everyday care, supporting broader access to mental health services for patients who might otherwise never reach specialty care.

Specialty care is still needed — not all psychiatric needs are most effectively and safely addressed in this model — but population screening is broadening equitable identification, and CoCM is enhancing access to necessary treatments.

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