Concert Health’s $14 million Series A funding led by Vertical Venture Partners with participation from Town Hall Ventures and Silicon Valley Bank reflects growing investor conviction that the Medicare-reimbursed Collaborative Care Management model represents financially sustainable pathway for behavioral health integration at scale, addressing persistent access gaps through remote psychiatric consultation supporting primary care physicians rather than requiring specialized mental health facility referrals.
Collaborative Care Management Model and Clinical Framework
The San Diego-based platform’s approach—embedding remotely-located care managers and psychiatric consultants within primary care workflows to address depression and anxiety identified through routine screening—operationalizes the Collaborative Care Management (CoCM) model that Medicare began reimbursing years ago but that many primary care practices have struggled implementing due to infrastructure requirements, workflow complexity, and inadequate understanding of reimbursement opportunities.
CoCM’s evidence base distinguishes it from many behavioral health innovations lacking rigorous outcome validation, as decades of research demonstrate that integrated collaborative care produces superior depression and anxiety outcomes compared to usual primary care treatment while proving cost-effective through reduced emergency department utilization, improved chronic disease management, and enhanced medication adherence. The model’s inclusion in Substance Abuse and Mental Health Services Administration’s evidence-based practices registry and support from organizations including American Psychiatric Association provides clinical credibility that purely commercial platforms often lack.
The workflow Concert describes—primary care physicians screen patients, “warm handoff” to remote care managers who develop treatment plans while coordinating between PCPs and psychiatric consultants—addresses fundamental access barriers where patients identified with behavioral health needs in primary care historically received referrals to specialty mental health providers but frequently never completed referrals due to long wait times, geographic barriers, stigma concerns, or care coordination failures between disconnected systems.
Care managers’ liaison role represents the operational innovation enabling collaborative care’s effectiveness, as these typically master’s-level social workers or counselors provide care coordination, patient education, symptom monitoring, and treatment adherence support that time-constrained primary care physicians cannot deliver while simultaneously consulting with psychiatric providers who guide medication management and treatment planning without requiring in-person patient encounters for every clinical decision.
However, the model’s dependence on remote care managers and psychiatrists raises workforce questions about whether sufficient qualified professionals exist to staff aggressive scaling across multiple states and dozens of partner organizations. Behavioral health workforce shortages affecting traditional service delivery similarly constrain collaborative care platforms, though remote work flexibility potentially expands recruitment pools beyond geographic constraints limiting facility-based employment.
Geographic Expansion Strategy and Partnership Development
Concert’s plan to double state presence from four to eight during 2021—adding Florida, North Carolina, New Mexico, and an undisclosed fourth state to existing Arizona, California, Connecticut, and New York operations—demonstrates capital deployment toward geographic diversification enabling partnerships with primary care organizations across diverse markets rather than concentrating in single region with limited growth ceiling.
CEO Spencer Hutchins’s characterization of building “infrastructure out for both clinical and administrative teams in those markets” acknowledges that multi-state expansion requires more than simply activating services remotely, instead demanding state-specific licensing for behavioral health professionals, regulatory compliance with varying state telehealth and supervision requirements, payer contracting establishing reimbursement arrangements, and potentially local presence for relationship building with partner organizations even when clinical services deliver virtually.
The 44 current partnerships spanning “giant Goliaths” like CommonSpirit—the nation’s second-largest nonprofit hospital system—alongside “proudly independent” physician practices illustrates Concert’s ability to serve diverse organizational scales and structures. Large health systems bring substantial patient volumes, sophisticated contracting capabilities, and typically well-developed quality infrastructure, while independent practices offer decision-making agility, strong physician ownership of workflows, and authentic community relationships that large systems sometimes sacrifice through bureaucratic processes.
Hutchins’s observation that large health systems “are taking interest in our model faster than we expected” suggests that sophisticated healthcare organizations recognize collaborative care’s evidence base and Medicare reimbursement support creates compelling value proposition compared to behavioral health integration approaches lacking comparable validation or sustainable financing. For systems struggling to implement collaborative care internally due to operational complexity or workforce constraints, Concert’s turnkey solution offering immediate deployment without requiring internal staff hiring and training presents attractive alternative.
However, the statement that Concert enables partners to “expand their service line in a way that they would almost certainly not be able to do if they tried to do it internally” also reveals potential vulnerability if larger health systems decide that collaborative care represents core strategic capability worth building despite implementation challenges. If major health systems invest in internal collaborative care infrastructure using Concert as temporary bridge rather than permanent solution, the platform could face customer churn as partners transition to internal models.
Reimbursement Model and Financial Sustainability
Concert’s reliance on the Medicare-reimbursed CoCM model provides crucial financial foundation distinguishing the platform from digital behavioral health startups dependent on employer contracts, direct consumer subscriptions, or unproven value-based payment arrangements. Medicare established specific Current Procedural Terminology (CPT) codes for collaborative care management in 2017, enabling primary care practices to bill for care coordination activities that previously lacked reimbursement mechanisms despite evidence supporting their clinical and economic value.
The CoCM billing structure typically involves monthly per-patient fees for ongoing care management once patients engage in collaborative care, with additional codes for psychiatric consultation time and initial patient engagement activities. These codes create recurring revenue streams supporting the care manager and psychiatric consultant infrastructure that collaborative care requires, making the model financially sustainable rather than dependent on practices absorbing costs hoping for indirect savings through improved outcomes.
Commercial insurance payers increasingly recognize CoCM codes following Medicare’s lead, though coverage varies across insurers and state markets. Medicaid programs have moved more slowly adopting collaborative care reimbursement, creating potential access disparities where practices serving predominantly Medicaid populations face financial barriers implementing collaborative care despite their patients’ high behavioral health needs.
