CMS' Innovative Behavioral Health model for states: New approach to mental health care

The Centers for Medicare & Medicaid Services on Thursday announced a new program designed to improve outcomes for adults with mental health and substance abuse disorders.

The Innovation in Behavioral Health (IBH) Model is intended to funnel adults in Medicare and Medicaid to the physical, behavioral and social supports they need. CMS will release a notice of funding opportunity this spring, and up to eight states will be selected to participate for the next eight years.

Community-based practices will create care teams with behavioral and physical health providers. Instead of being squeezed into primary care settings, the new model calls for “weaving” physical health needs into behavioral health organizations, CMS Deputy Administrator Liz Fowler said.

One in four Medicare enrollees and 40% of all adults enrolled in Medicaid experience mental illness or substance abuse disorders, according to CMS. People with behavioral health needs often have trouble accessing necessary health care, have unmet health-related social needs, experience poor health outcomes and may die prematurely.

Limited access to care, stigma and untreated or poorly managed chronic conditions such as diabetes and heart disease can contribute to worsening health outcomes for these populations. Behavioral health providers face significant barriers to delivering care because of a lack of resources and a fragmented health-care delivery system that does not systematically integrate behavioral and physical health care.

Practice participants will lead an interprofessional care team and be responsible for coordinating with other members of the care team to comprehensively address a patient’s care to include behavioral and physical health, and health-related social needs such as housing, food, and transportation.

These participants will conduct an initial screening and assessment, offer treatment or referrals to other care specialists and community-based resources, and monitor ongoing behavioral and physical health conditions and health-related social needs. In this value-based care approach, the practice participants will be compensated based on the quality of care provided and improved patient outcomes.

States selected to participate in the voluntary model will be responsible for ensuring delivery of integrated care, with comprehensive care coordination and care management, to fully support an individual’s care needs. As a result, people served by this model can expect to receive more integrated care that may result in fewer visits to the emergency department and improved behavioral and physical health outcomes.

Related: New York cracking down on insurers’ ‘ghost providers’ amid mental health crisis

“The Innovation in Behavioral Health Model aims to help participating practices improve access to and promote high-quality integrated care,” according to CMS. “By supporting behavioral health practices to lead an interprofessional care team, the model will address patients’ behavioral and physical health and health-related social needs.”

CMS will release a Notice of Funding Opportunity in Spring 2024 and up to eight states will be selected to participate. The model will launch in Fall 2024 and run for eight years.