Moore County Hospital District Collaborative Care

Several people enrolled in the program have been able to avoid potential hospitalizations. They were waiting for psychiatrist appointments and were at risk for decompensation. They have been able to avoid disruptions in their home and work. One patient stated that she felt ‘seen’ due to being engaged in the community.”
Anne Blanscet, LCSW Behavioral Health Care Manager, Moore County Hospital District

Regional Details

Location: Two internal medicine clinics, one rural health clinic, and one OBGYN clinic in the Texas Panhandle
Local Population: Moore County, Texas, with a population of approximately 21,190

Site Details

MCHD serves Dumas, Texas, a small rural community in Moore County. The district operates a critical access hospital and seven clinics, including three primary care sites, one of which is designated as a rural health clinic. Across these sites, nine physicians and eight advanced practice providers deliver care to a diverse adult patient population. For CoCM services, MCHD is reimbursed by all major commercial payors, as well as Medicare and Medicaid, demonstrating broad financial support for integrated behavioral health care.

Program Launch and Technical Assistance

The Meadows Institute began providing tailored technical assistance (TA) to MCHD four months before the launch of its CoCM program to help establish the foundation for successful implementation. Early support focused on training two primary care providers (PCPs) on CoCM workflows and preparing the behavioral health care manager (BHCM) to use measurement-informed care and deliver evidence-based interventions as part of the CoCM team. Since the program’s launch, the Meadows Institute has continued to provide ongoing TA for more than a year, including regular workflow meetings, semi-annual data reviews, and integration of referral workflows into the electronic health record (EHR).

Workflow

MCHD’s CoCM team includes a PCP, a BHCM, and a psychiatric consultant. Nurses administer the PHQ-2 depression screening during every patient visit, with a follow-up PHQ-9 assessment for patients with positive PHQ-2 screens. When a PHQ-9 indicates risk, results are quickly shared with the PCP, who refers patients ages 18 and older to the CoCM program and connects them directly to the BHCM. Because patients in this close-knit rural community often have long-standing relationships with their PCPs, these warm connections help build trust and increase program engagement. The BHCM also plays a central role: meeting patients during PCP visits, conducting in-person follow-ups with patients who are not showing signs of improvement, helping patients navigate the healthcare system, and reducing barriers and strengthening engagement.

Billing

Medicare began reimbursing for CoCM services in 2017 and has since expanded coverage to include rural health clinics. Many commercial insurers and Texas Medicaid also reimburse for CoCM, though payment rates vary. MCHD successfully bills for CoCM services in both rural health clinic and non-rural health clinic settings. Before submitting claims, the team reviews insurance benefits for referred patients and explains any potential cost-sharing requirements, such as co-pays. Recognizing that these out-of-pocket costs can be significant barriers, providers and the CoCM team work diligently to keep care accessible while maintaining program sustainability.

Community Partnerships

MCHD has built strong partnerships with a local employer, expanding behavioral health access for their employees. By covering employee co-pays, the employer reduces financial barriers to care. This partnership, combined with MCHD’s trusted presence in the Dumas community, has strengthened program success and improved access, particularly among immigrant and low-income populations.

Conclusion

The CoCM program at MCHD is improving access to behavioral health services in a region with pronounced provider shortages. Their success has been driven by strong in-person engagement strategies, trust-building between PCPs and patients, active involvement of the BHCM, and employer partnerships that reduce financial barriers. MCHD’s CoCM program has the potential to further expand access and improve outcomes across the Texas Panhandle, serving as a model for rural health systems across Texas and beyond.

There are a lot of barriers to accessing behavioral health care in rural communities. There is a shortage of providers, the local mental health authority is understaffed, and there are long wait times to be seen by a psychiatrist. Some people wait more than six months to be seen. By enabling people to have their behavioral health care needs met in the primary care setting, we can eliminate many of these barriers.”
Anne Blanscet, LCSW Behavioral Health Care Manager, Moore County Hospital District

For information on Collaborative Care technical assistance and implementation view our mmhpi.org/cocm resources.

¹County Health Rankings & Roadmaps. (2024) Mental Health Providers. County Health Rankings. https://www.countyhealthrankings.org/health-data/texas/randall