Massachusetts Collaborative Care Model

A model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients

Recognizing the barriers to Office-Based Opioid Treatment with Buprenorphine (OBOT-B), in 2003, a multidisciplinary team at Boston Medical Center (BMC) created the Massachusetts Collaborative Care Model to increase access to treatment. The goal of this state OBOT-B program was to incorporate the model into primary care in community health centers, providing treatment to marginalized individuals including the homeless, under-insured, uninsured, ethnic and racial minorities and those with co-occurring physical or mental health disorders. The model consists of four treatment stages: 1) screening and assessment of the patient’s appropriateness for office-based treatment; 2) medication induction under a Nurse Care Manager’s direct supervision; 3) stabilization; and 4) maintenance.

The Nurse Care Manager (NCM) is central to the OBOT-B Collaborative Care Model. The NCM is usually the initial contact for patients seeking OBOT-B treatment and acts as the primary liaison between the patient and the physician throughout the treatment process. With the NCM as the first point of contact, patients have access to the OBOT-B team for questions, issues or support during induction and as needed throughout treatment. During treatment stabilization, patients are followed closely with weekly or more frequent visits as well as telephone communication to provide support and education, assure adherence, and address other concerns the patient may have. The frequency of follow-up visits with the NCM usually decreases but can increase based on the patient’s needs.

This model for treating opioid dependence mirrors the model for treating other chronic diseases in that management is individualized and includes OBOT-B clinical contacts and referrals to specialized care based on patient need. More information on implementing this program can be found in this presentation

More information on this model can be found in this write up and this presentation

This model increased the number of healthcare professionals that could prescribe buprenorphine by 375%.

Continuum of Care
Type of Evidence
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article

Evidence of Program Effectiveness

“The expansion of OBOT to the fourteen community health centers (CHCs) increased the number of physicians who were “waivered” (i.e., enabling their prescribing of buprenorphine) by 375%, from 24 to 114, within 3 years. During this period the annual admissions of OBOT patients to CHCs markedly increased. Dissemination of the Massachusetts Model of the Office-Based Opioid Treatment with Buprenorphine employing a collaborative care model with a central role for nursing enabled implementation of effective treatment for patients with an opioid use disorder at community health centers throughout Massachusetts while effectively engaging primary care physicians in this endeavor.” (LaBelle et al., 2016)