The behavioral health sector “is ripe with opportunities to improve” as the Biden administration continues to prioritize mental health and addictions treatment.
That’s according to Tequila Terry, group director of state innovation and prevention and population health at the Center for Medicare & Medicaid Innovation (CMMI). This improvement could mean behavioral health is integrated even further into future CMMI models.
“We are thinking about both the opportunity to focus specifically on behavioral health models as a potential design, … and focusing on the opportunity to incorporate behavioral health in our models that are not particularly behavioral health-focused but have people who could benefit from incorporating those elements,” Terry said during a fireside chat at the Behavioral Health Business VALUE event.
While new models may be on the horizon, Terry was tight lipped about when the public can expect the rollout.
“I can’t say this year explicitly. … The process for developing models does take some time, and we are still in the exploration days,” Terry said. “What I will say specifically is this is something that is important to us.”
That statement pertains to almost everyone at “the highest levels” of federal government, she explained, from CMMI leaders and other U.S. Centers for Medicare & Medicaid Services (CMS) officials, to the White House.
“So what that means is from a [CMS] Innovation Center standpoint, we are going to be looking at where our authority can come into play to improve access, to improve outcomes, and really to focus on creative and innovative ways to engage providers who frankly haven’t been a part of the value-based movement,” Terry said.
Outcomes remain a key aspect of CMS’ behavioral health strategy. The federal government is using a collaborative approach to evaluating outcomes in behavioral health. Specifically, Terry said there is an effort across agencies to use data in order to evaluate outcomes.
“We have just formed across HHS (the U.S. Department of Health and Human Services) and CMS a data coordinating counsel,” she said. “As we progress, we will certainly be looking at things like disparities, access to care, utilization of hospital services for mental health issues, looking at crisis services. I think there will be a lot of opportunity as that council gets underway to define what specific outcomes we want to measure.
Terry noted that CMS is uniquely positioned to look across Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and other areas to gain insights into diverse populations.
To make changes in the space, CMMI will seek input from behavioral health stakeholders. Historically, CMMI designed new models before sharing them with the industry. However, the agency is now looking to shift that paradigm.
“So what we want to do as we move forward is to host listening sessions and engage with organizations, again, that are subject matter experts in this space, so we can get your input earlier in the design process,” she said.
Bringing industry stakeholders into the fold early on in the design process could help create more alignment between the public and private sectors.
“I think there is an opportunity to bring both the public sector and the private sector together to coordinate, align and to identify improvement opportunities,” Terry said.
A focus on equity
While Medicaid is the largest payer for mental health services in the United States, its members often face barriers accessing care. However, the Biden administration’s focus on equity in behavioral health could lead to new payment innovation in the space.
“Medicaid is a tremendous part of our overall strategy as we move forward,” Terry said. “If our goal is to focus on improving health equity we have got to have a more equitable reach across all the populations.”
In April, CMS released a new behavioral health strategy, which has a heavy emphasis on equity and access. The strategy stresses the importance of incorporating health equity into care and payment models for at-risk behavioral health needs.
“Historically, we have done a lot of work in the Medicare space, and now we are starting to think about what we can do to make sure that Medicaid beneficiaries actually benefit from the care transformation, from the payment-reform activity that we do across our models,” Terry said.
The agency has a number of programs supporting Medicaid recipients. At VALUE, Terry highlighted the Maternal Opioid Misuse (MOM) model, which is a “model of care that wraps the woman, the baby into services that focus on both physical health and behavioral health needs, treatment needs.”
A collaborative approach
Again, Terry stressed that CMMI is looking for public and private stakeholder involvement as a key part of the overall strategy. She noted that there is a deliberate effort to collaborate and work with safety-net providers.
“We know that Medicare beneficiaries seek their care from safety-net providers, though those providers aren’t always represented in our models,” she said. “They don’t participate, they don’t apply. So we have to do some work to figure out how to solve that.”
The agency is also looking to work creatively with states to address some of the unmet needs.
“States have really unique authority to be able to engage beneficiaries in a way that addresses cost and quality drives,” Terry said. “We want to make sure as we design models of the future that states are actively engaged and feel they can participate in meaningful ways in our models.”
Community support is another fundamental part of the plan, according to Terry.
“As we are engaging and thinking about making an impact in Medicaid, we think there are a lot of opportunities to engage community resources, to provide services, to do screenings of social needs,” she said.
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