Advancing health equity in oncology: Virtual collaborative behavioral health engagement and outcomes among Medicaid-insured and BIPOC patients.

Abstract

1552 Background: Depression and anxiety are common among patients with cancer, yet access to behavioral health care remains limited, particularly for Medicaid-insured and racially minoritized populations. We evaluated reach, baseline symptom burden, and longitudinal outcomes of a virtual collaborative behavioral health program embedded within community oncology. Methods: We conducted a retrospective cohort study of patients referred to a virtual collaborative behavioral health program (Cerula Care) across community oncology practices from 2024–2026. Outcomes included representation of Medicaid-insured and BIPOC patients among those initiating care, baseline symptom burden assessed by PHQ-9, GAD-7, and FACT-G7 stratified by insurance (Medicaid vs commercial+Medicare) and race/ethnicity (BIPOC vs White), and longitudinal symptom change during program participation. Independent t-tests were used for between-group comparisons, and paired t-tests were used for within-patient comparisons. Results: Between program launch and data cutoff, 1,400 patients were referred by oncology providers; 850 consented and scheduled an intake, and 631 completed intake and initiated behavioral health care. Among 631 patients initiating behavioral health care, 43.5% identified as BIPOC (36.5% Black) and 18.7% were Medicaid-insured, indicating a strong reach into populations historically underserved by behavioral health services. Baseline symptom severity was significantly higher among Medicaid-insured compared with commercial+Medicare patients across all measures, indicating clinically meaningful greater symptom burden. Baseline severity did not differ by race/ethnicity. Improvements in depression, anxiety, and quality of life were observed over time. Between-group differences in symptom improvement by insurance or race were not statistically significant, though Medicaid-insured and BIPOC patients showed directionally greater PHQ-9 and FACT-G7 improvement, and Medicaid-insured greater GAD-7 improvement. Patient-reported experience indicated high acceptability (Net Promoter Score 88); 60% reported improved oncology visit adherence and 61% improved adherence to non chemotherapy medications. Conclusions: Embedding virtual collaborative behavioral health in community oncology was associated with high reach among Medicaid-insured and BIPOC patients. Medicaid-insured patients entered care with greater symptom burden yet experienced symptom improvements comparable to commercially ensured and Medicare patients, with similar outcomes across racial/ethnic groups. These findings support collaborative care as a scalable strategy to expand access to behavioral health services and promote equitable supportive oncology care.