Alliance Note: The Centers for Medicare and Medicaid Services (CMS) will be testing a new model of care integrating behavioral and physical health services for people enrolled in Medicaid and Medicare. The Integration for Behavioral Health (IBH) model aims to improve coordination between various providers by creating interdisciplinary teams with providers offering physical health, mental health, substance use, and community-based services. These teams will be charged with tracking and providing services for peoples’ physical, behavioral, and social care needs.
This innovation comes as the federal government pushes states to increase the integration of health care services. Improving holistic care and coordination between various providers has been a goal of the Biden Administration and the Department of Health and Human Services (HHS). CMS will award eight (8) states with eight-year demonstration contracts to determine the effectiveness of the IBH model. The funding also includes money to improve healthcare infrastructure, including to bolster IT and electronic health records. See below for more information.
New CMMI Model Integrates Physical and Behavioral Health
By Susan Morse |Healthcare Finance | January 22, 2023
The Centers for Medicare and Medicaid Services has announced a new model to test approaches for addressing behavioral and physical health, as well as social needs, for people with Medicaid and Medicare.
The model will launch in the fall 2024 and is anticipated to operate for eight years in up to eight states. CMS is expected to release a Notice of Funding Opportunity this spring.
Practice participants in the Integration for Behavioral Health Model will be community-based behavioral health organizations and providers, including Community Mental Health Centers, public or private practices, opioid treatment programs, and safety net providers where individuals can receive outpatient mental health and SUD services.
The Center for Medicare and Medicaid Innovation model will incentivize practice participants to work collaboratively to screen, assess and coordinate between individuals’ physical and behavioral health needs by being given the resources to facilitate integrated care.
This includes infrastructure payments to support health IT capacity building, electronic health records, and practice transformation; technical assistance; and a predictable value-based payment model.
WHY THIS MATTERS
The goal is the integration of services that will bridge the gaps between physical and behavioral health.
Twenty-five percent of people with Medicare experience mental illness and 40% of adult people with Medicaid experience mental illness or substance use disorder, according to CMS.
High out-of-pocket costs for care, lack of access to behavioral health treatment and fragmented systems of care can make it difficult for people to obtain behavioral healthcare. This is particularly true for historically marginalized racial and ethnic groups, low-income populations, and individuals living in rural areas, CMS said.
The Innovation in Behavioral Health Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral and social supports needed to manage their care.
Under the model, community-based behavioral health practices will form interprofessional care teams consisting of behavioral and physical health providers, as well as community-based supports.
The goal is the integration of services that will bridge the gaps between physical and behavioral health. The model enables a “no wrong door” approach, meaning that regardless of how patients enter care, they will have access to all available services.
Through this practice, the model also aims to reduce overall program expenditures, CMS said. Evernorth data shows that 22% of patients with a diagnosed behavioral condition drive 41% of total healthcare spend.
THE LARGER TREND
This new model supports President Biden’s mental health strategy and implements an action item in the Department of Health and Human Services Roadmap for Behavioral Health integration.
It builds upon earlier CMMI efforts to include community-based behavioral health practices, including both mental health providers and substance use disorder providers, in value-based care. It is based on the lessons learned from previous models, such as the Maternal Opioid Misuse Model, Integrated Care for Kids Model and the Value in Opioid Use Disorder Treatment Demonstration.
ON THE RECORD
“The systems of care to address physical and behavioral health conditions have historically been siloed, but there is a direct correlation between people with mental health conditions or substance use disorder and poor physical health,” said CMS Deputy Administrator and Innovation Center Director Liz Fowler. “This model will bring historically siloed parts of the health system together to provide whole-person care – designed to keep people out of the emergency department, ensuring better care management and coordination, and improving their overall health.”
“The IBH Model will help improve the quality of care and health outcomes for people with moderate to severe behavioral health conditions,” said Dr. Miriam E. Delphin-Rittmon, HHS Assistant Secretary for Mental Health and Substance Use and the leader of the Substance Abuse and Mental Health Services Administration (SAMHSA). “Additionally, this model will enhance the behavioral health system infrastructure and the staffing to support it.”
HHS Unveils New Model to Encourage Behavioral Health Integration
By Dorothy Mills-Gregg | Inside Health Policy | January 22, 2024
Mental health advocates are cheering the Biden administration’s new Innovation in Behavioral Health (IBH) Model that will encourage more providers to integrate behavioral health care with physical health care — though some stakeholders initially weren’t sure how the new demonstration differs from the popular Certified Community Behavioral Health Clinic model. HHS staff say they expect the two programs to complement each other.
“CCBHCs can certainly be part of this, and I think we hope that that CCBHCs will engage in this opportunity, but it really is we will allow them to take the core elements of the CCBHC program and layer in this really important element around integration, which is not a current required service within the CCBHC model,” an HHS staffer said during a stakeholder call Thursday (Jan. 18) when the new model was unveiled.
Up to eight states will be selected for CMS’ first innovation model for 2024 to run over eight years an integrated health care program designed for Medicaid and Medicare beneficiaries who have moderate to severe behavioral health conditions. Providers selected to participate in the IBH model will be expected to develop multidisciplinary care teams that coordinate and track beneficiaries’ physical, psychosocial and behavioral health.
The model will also fund updates for health information technology, investments in interoperability and in tools like electronic health records, which let providers improve quality reporting and data sharing.
“[W]hen a quarter of all your Medicare beneficiaries, and four in every 10 of your Medicaid beneficiaries need behavioral health services, you better be doing something,” HHS Secretary Xaiver Becerra said in a stakeholders call. “And so CMS has an obligation to try to make sure that we’re tackling this issue of behavioral health in the right way for Americans period and certainly for Medicaid and Medicare beneficiaries.”
Chuck Ingoglia, National Council for Mental Wellbeing president and CEO, said the demonstration is long overdue and added that CCBHCs will be an “obvious vehicle to provide these services.”
“The state-based Innovation and Behavioral Health Model will help Medicare and Medicaid beneficiaries because it will provide resources to achieve whole-person health care,” Ingoglia said in a statement. “Not only does integration provide opportunities to improve health outcomes, it also allows communities to improve health equity.”
Experts say integrating care means more Medicare and Medicaid beneficiaries with behavioral health conditions will also be able to access treatment for any chronic health maladies, like diabetes and heart disease.
Meanwhile, Rep. Doris Matsui (D-CA) celebrated the new model for its investments in health technology. In October, Matsui asked the CMS Innovation center to create a model that incentivizes behavioral health providers to adopt health information technology. “The benefits are clear — connected, coordinated care leads to better health outcomes and better overall quality of care,” Matsui said in a statement. “That’s why I have been such a strong advocate for integrated, whole-person care between physicians and behavioral health providers. Adoption of health IT systems is a crucial catalyst to make that happen.”