The Centers for Medicare & Medicaid Services (CMS) is working to improve access to behavioral health with a new initiative designed to integrate behavioral health with physical health.
The newly launched program, called the Innovation in Behavioral Health (IBH) Model, will connect adults with mental health conditions or substance use disorders (SUDs) to physical, behavioral and social supports by prioritizing close collaboration with primary care and physical health providers.
The state-based initiative, led by Medicaid agencies, will align payments between Medicare and Medicaid for integrated services. Patients will work with a trusted behavioral health provider, facilitating their care across screenings, assessments, referrals and community support.
“For people with moderate and severe behavioral health needs this integrated approach will help them stay engaged and ultimately reach their health goals,” Andrea Palm, deputy secretary of the Department of Health and Human Services, said. “We know a lot of innovation in behavioral health is happening around the country in state Medicaid programs. The model will build on that innovation to deliver a set of services that people with Medicare and Medicaid need.”
The IBH model is delivering on the Biden-Harris administration’s commitment to integration, according to Carlos Lindo, senior vice president of legal and compliance at Lucet.
“This is a great opportunity for behavioral health providers to increase their payment but also to show a true impact on how members are being treated and to show what the outcomes are,” Lindo told Behavioral Health Business.
Kansas City, Missouri-based Lucet is a behavioral health optimization company for health plans.
How the IBH model works
The initiative will work through a “reverse integration” approach.
“In the past, we’ve thought about primary care providers and then tried to integrate behavioral health into primary care,” Liz Fowler, deputy administrator and director of the CMS Innovation Center, said. “This is really focused on community-based behavioral health organizations and trying to weave physical health needs into that.”
Community-based behavioral health providers, including public and private practices, opioid treatment programs and safety net providers will form inter-professional care teams to integrate previously siloed services.
Behavioral health providers participating in the program will be equipped with resources to screen and provide basic primary care services and meet health-related social needs. Resources will include infrastructure payments, electronic health records (EHRs), technical assistance and a predictable value-based payment model.
“The IT [aspect] is probably the most intriguing and interesting part of this to me,” Lindo said. “If you get the right systems that have certain measurement-based care tools, then it’s going to allow connection with other providers and enable provider-based outcomes.”
The IBH model will take a “no wrong door approach” to offering patients care, designed to reduce overall program expenditures and improve care access.
“When we say the IBH model supports a ‘No Wrong Door’ approach to care, we mean that when our family members, friends or [we ourselves] go to a behavioral health provider, the model opens doors to all types of care,” Miriam Delphin-Rittmon, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration (SAMHSA), said.
Why integration is important
Behavioral health conditions significantly impact Medicaid and Medicare population, driving the need for improved access to care, with 25% of Medicare beneficiaries and 40% of Medicaid beneficiaries affected.
Policy changes are a key stepping stone for successful primary and behavioral care integration.
“If we are looking at people with moderate to severe mental illness or substance use disorder, we know that those communities and those populations are most comfortable getting their care in a specialty behavioral health setting,” Trina Dutta, SAMHSA’s chief of staff, said. “Quite frankly, oftentimes primary care providers don’t have the training, time or capacity that is necessary to serve this population.”
The IBH Model will launch in up to eight states in the fall of 2024 and is anticipated to operate for eight years. States will have the chance to apply to participate in spring.
The eight-year plan, broken up into two phases, is a “long time,” according to Lindo.
“For the program to succeed it has to stay fresh,” he said. “If this model doesn’t stay up-to-date in terms of what IT infrastructures is needed, then I think it’s going to fall quickly to the wayside, lost in translation or the commercial market is going to zoom ahead.”
