New model seeks to improve quality of care, access, and outcomes for people with mental health conditions and substance use disorders in Medicaid and Medicare
Today, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), is announcing a new model to test approaches for addressing the behavioral and physical health, as well as health-related social needs, of people with Medicaid and Medicare. The Innovation in Behavioral Health (IBH) Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care. The model will also promote health information technology (health IT) capacity building through infrastructure payments and other activities.
The IBH Model will be tested by the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Under IBH, community-based behavioral health practices will form interprofessional care teams consisting of behavioral and physical health providers, as well as community-based supports. This new model supports the President’s mental health strategy and implements an action item in the HHS Roadmap for BH integration.
“I am proud of all the work we have done to change the way mental health is treated in this country for the better. This new behavioral health model released today will help states to advance this goal, in line with the President’s Unity Agenda priority to tackle the mental health crisis,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration will continue to explore innovative ways to help people with mental health conditions and/or substance use disorder. Put simply, mental health is health—and by expanding access to the high-quality care that people need, we are changing lives.”
Through the interprofessional care teams, people will experience an integration of services that will bridge the gaps between physical and behavioral health. The model enables a “no wrong door” approach, meaning that regardless of how patients enter care, they will have access to all available services. Through this practice, IBH also aims to reduce overall program expenditures.
“The Biden-Harris Administration believes that treating mental health and substance use disorder requires a “no wrong door” approach. This new model ensures that anyone can get access to the services they need, regardless of how they enter care,” said HHS Deputy Secretary Andrea Palm. “We will continue to test approaches that close the gaps between how behavioral and physical health are treated. Our goal is always to improve the overall quality of care and outcomes for patients and this model brings us one step closer.”
“Addressing the nation’s behavioral health crisis remains a key priority for CMS,” said CMS Administrator Chiquita Brooks-LaSure. “Through this model, CMS will support behavioral health practices to provide integrated care and help meet people’s behavioral and physical health and health-related social needs, like housing, food, and transportation, all of which can negatively impact a person’s ability to manage their care.”
“The IBH Model will help improve the quality of care and health outcomes for people with moderate to severe behavioral health conditions,” said HHS Assistant Secretary for Mental Health and Substance Use and the leader of the Substance Abuse and Mental Health Services Administration (SAMHSA), Dr. Miriam E. Delphin-Rittmon. “Additionally, this model will enhance the behavioral health system infrastructure and the staffing to support it.”
The impact of behavioral health conditions is significant among the Medicare and Medicaid populations, with 25% of people with Medicare experiencing mental illness and 40% of adult people with Medicaid experiencing mental illness or substance use disorder (SUD).[1] High out-of-pocket costs for care, lack of access to quality behavioral health treatment in some areas, and often fragmented systems of care can make it difficult for people to obtain the care they need. This is particularly true for historically marginalized racial and ethnic groups, low-income populations, and individuals living in rural areas.
“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,” said CMS Deputy Administrator and Innovation Center Director Liz Fowler. “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.”
Practice participants in the IBH Model will be community-based behavioral health organizations and providers, including Community Mental Health Centers, public or private practices, opioid treatment programs, and safety net providers where individuals can receive outpatient mental health and SUD services. The model will incentivize these practice participants to work collaboratively to screen, assess, and coordinate between individuals’ physical and behavioral health needs. Practice participants will be equipped with the necessary resources to facilitate integrated care, including infrastructure payments to support health IT capacity building, electronic health records, and practice transformation; technical assistance; and a predictable value-based payment model.
The IBH Model builds upon earlier Innovation Center efforts to include community-based behavioral health practices, including both mental health providers and substance use disorder providers, in value-based care. The IBH Model is based on the lessons learned from previous Innovation Center models, such as the Maternal Opioid Misuse Model, Integrated Care for Kids Model, and the Value in Opioid Use Disorder Treatment Demonstration.
The model will launch in Fall 2024 and is anticipated to operate for eight years in up to eight states. CMS will release a Notice of Funding Opportunity for the model in Spring 2024.
Please visit the IBH Model webpage for more information: https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model
For Frequently Asked Questions about the Innovation in Behavioral Health Model, please visit: https://www.cms.gov/ibh-model-frequently-asked-questions
For a fact sheet on the model, please visit: https://www.cms.gov/files/document/ibh-fact-sheet.pdf
View a fact sheet of the accomplishments to date on the HHS Roadmap for Behavioral Health Integration: https://www.hhs.gov/about/news/2024/01/18/hhs-roadmap-for-behavioral-health-integration-fact-sheet-accomplishments.html
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[1] Nearly 40% of the nonelderly adult Medicaid population had a mental health or SUD in 2020.
Source: https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs/#:~:text=Medicaid%20plays%20a%20key%20role,disorder%20(SUD)%20in%202020; about one in four Medicare beneficiaries live with mental illness (31% in traditional Medicare, 28% in Medicare Advantage plans)