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CMS Announces Model to Integrate Behavioral and Physical Healthcare
On Thursday, the US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), introduced a new model aimed at advancing the integration of behavioral and physical healthcare, as well as health-related social needs, for people with Medicaid and Medicare.
About 25% of individuals with Medicare experience mental illness and 40% of adults with Medicaid experience mental illness or SUD, according to past research.
The goal of the initiative, known as the Innovation in Behavioral Health (IBH) Model, is to improve quality of care and outcomes for adults with mental health conditions and/or substance use disorders (SUDs) by connecting them with appropriate supports to manage their care.
The new model will be tested by the CMS Innovation Center, with community-based behavioral health practices forming interprofessional care teams comprised of behavioral and physical healthcare providers, along with community-based supports. By integrating services, HHS hopes to bridge gaps between physical and behavioral health and reduce program expenditures by enabling a “no wrong door” approach: regardless of how patients enter care, they will have access to all services.
“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,” CMS Deputy Administrator and Innovation Center Director Liz Fowler said in a news release. “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.”
Chuck Ingoglia, president and CEO for the National Council for Mental Wellbeing, lauded the CMS announcement in a statement on Thursday.
“Integrating care for behavioral health with primary care is long overdue,” Ingoglia said. “We applaud CMS for its attention to this long-standing problem. “The state-based Innovation and Behavioral Health Model will help Medicare and Medicaid beneficiaries because it will provide resources to achieve whole-person health care. Not only does integration provide opportunities to improve health outcomes, it also allows communities to improve health equity.”
IBH Model practice participants will include community-based behavioral health organizations and providers, including Community Mental Health Centers, public or private practices, opioid treatment programs, and safety net providers that deliver outpatient mental health and SUD treatment services. Practice participants will be incentivized to work collaboratively to screen, assess, and coordinate to address individuals’ physical and behavioral health needs.
Participants will be provided with resources necessary for facilitating integrated care, including infrastructure payments supporting expansion of health IT capacity, electronic health records, and practice transformation, as well as technical assistance and implementation of a predictable value-based payment model.
The IBH Model is slated to launch in fall 2024, operating for 8 years in up to 8 states. A Notice of Funding Opportunity is expected to be released by CMS in spring 2024.
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