Behavioral health integration will play a major role in The Centers for Medicare & Medicaid Services’ (CMS) latest cost control initiative.
On Tuesday, CMS unveiled the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model). It is an 11-year total cost-of-care reduction model meant to give state governments the tools to reduce spending and increase quality.
The plan focuses on strengthening primary care, enhancing care coordination for those on Medicare and Medicaid plans, and increasing screening for referral to community resources.
“Participating primary care practices will be required to engage in behavioral health integration activities as a component of Primary Care AHEAD care transformation requirements,” CMS said in a FAQ sheet for the announcement.
The program will be available to eight states, and each may get up to $12 million in implementation funding.
“In our current health care system, fragmented care contributes to persistent, widening health disparities in underserved populations,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The AHEAD Model is a critical step towards addressing disparities in both health care and health equity while improving overall population health.”
The AHEAD Model intends to develop fixed, global budgets for hospitals’ Medicare and Medicaid funding. The model also calls for private payers and hospitals to collaborate on global budgets. These are meant to stabilize hospital finances, the release states.
Primary care providers will receive more funding from Medicare and Medicaid. CMS will assess these providers for prospective payments based on their success on quality measures, behavioral health integration and ability to address social determinants of health, the release states.
Each state sets a Medicare total cost target in partnership with CMS. The states develop a similar total cost target for spending from all payer sources.
“States will also have a Medicare and an all-payer primary care investment target to enhance primary care delivery,” the release states.
CMS will release more information about the funding opportunities late in the Fall of 2023 and will have an application period in the spring of 2023.
The funding and program will have three cohorts with various start dates, implementation and planning periods. Each will either start in January 2026 or January 2027. The model concludes in December 2034.
The AHEAD Model doesn’t contemplate a bi-directional integration of behavioral health and primary care. This is a key approach for the strategic priorities developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and released in August.