New CMMI model integrates physical and behavioral health

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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 the 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."

Email the writer: SMorse@himss.org