How CMS’ Primary Care Plus Model Triggered Massive Behavioral Health Integration

Forty-five percent of providers that used the Comprehensive Primary Care Plus model (CPC+) reported co-locating behavioral health services in their clinics.

That’s according to a recent evaluation report released by the Center for Medicare & Medicaid Innovation (CMMI).

CPC+ was a test of how primary care providers can form close partnerships with the federal government, health plans and technology firms. The program was designed to “enable primary care practices to transform how they deliver care.”

CMMI launched the program in 2017. As of last year, it impacted more than 17 million patients.

While the CPC+ demonstration ended at the end of last year, policymakers and health care stakeholders are still using it as a source of inspiration for future care delivery innovation. CPC+, in fact, served as an inspiration to the newer Primary Care First initiative.

 All 3,070 primary care practices involved with CPC+ (99%) were implementing a behavioral health strategy, according to the recent CMMI report. 

CMMI is part of the U.S. Centers for Medicare & Medicaid Services (CMS), one of the federal government’s most potent health care regulators.

The program split providers into two tracks. Track 1 in 2021 saw 45% of participants co-locating behavioral health services in their clinics. In 2020, that number was 34%. Track 2 saw 68% of clinics doing so in 2021. Previously, the share was 64%.

The two tracks were meant to act as proxies for new and different ways of providing primary care.

Track 1 operated with some enhancements to a traditional primary care model, including enhanced payments and program support from partner organizations.

Track 2 required participants to adopt more nontraditional measures. These included reducing or eliminating fee-for-service payment models with CMS and the payer partners involved. Instead, payers provided advanced lump-sum payment regardless of the number or type of visits performed. They also

During the fourth year, both Track 1 and Track 2 practices were required to provide behavioral health integration (BHI). They had two potential tracks: the Primary Care Behaviorist model than the Care Management for Mental Illness model. The former required onsite behaviorists. The latter required practices to have care managers trained in behavioral health practices to help coordinate care.

“Similar to [program year 3], 57% of practices reported to CMS that they opted for the Primary Care Behaviorist model, 36% opted for the Care Management for Mental Illness model, and 5% indicated that they use a combination of the two approaches,” the report stated.

Providers were able to add these behavioral health services because of the CPC+’s added funding support.

“All of the [practices CMMI] interviewed about PY 4 payment continued to describe care management fees as the most useful type of payment support they received,” the report states.

The large prospective payments provide stable revenue to pay for care managers and/or care coordinators as well as behavioral health providers, data analysts, population health coordinators, and clinical pharmacists.

However, practices told CMMI they worry about the sustainability of BHI and other efforts when the CPC+ model ends.

“Many [practices CMMI interviewed] want to sustain BHI, given its value, although several were uncertain how they would finance it,” the report states. “Notably, several [practices CMMI interviewed] indicated they were currently billing insurers for their behavioral health services.”

The report also found some practices struggled to find the professionals needed to staff BHI efforts, face shortages of community-based behavioral health resources, found some patients resisted behavioral health services, and that electronic medical records didn’t allow for behavioral health services documentation.