Behavioral health integration is an evidence-based approach to treating common behavioral health conditions — like anxiety and depression — and most often is associated with care that is integrated into the primary care setting. The integration of behavioral health and primary care has been shown to alleviate the pressures of a limited behavioral health workforce and lead to better outcomes.
However, primary care is not always equipped to handle all conditions and not all patients have established relationships with primary care providers. Those with more complex behavioral health needs may have established relationships with specialty behavioral health clinics and turn to those providers for their usual source of care.
Specialty behavioral health settings provide services for more complex behavioral health needs such as psychosis and are less likely to be integrated with other health care services. This arises in part because these providers often lack the resources to coordinate with other care providers, integrate physical health care interventions and providers, or align informational technology systems. This lack of coordination can present a significant challenge for patients, who often have unaddressed physical health conditions.
Alternative Payment Models and Behavioral Health
Behavioral health is often most effectively provided using flexible models of team-based care tailored to meet the needs of each individual. Yet these models don’t always fit neatly into traditional fee-for-service payments. Alternative payment models (APMs) offer greater payment flexibility for clinicians and, when coupled with infrastructure investment, hold promise for advancing integration of physical health care into behavioral health specialty care.
The Centers for Medicare and Medicaid Services (CMS) has included behavioral health in its more general APMs, like accountable care organizations (ACOs), but the models have not demonstrated strong outcomes in behavioral health. Instead, research has found that ACOs provided fewer behavioral health services and achieved poor outcomes. This may be because behavioral health specialty care providers did not have the capacity or infrastructure to participate in these APMs.
Integrated Behavioral Health Model
CMS’s Innovation Center recently announced the Integrated Behavioral Health (IBH) model as a way to allow states to advance access to behavioral health care for people with more complex needs who seek care from specialty behavioral health providers. The IBH model is one of the first major federal APMs centered on mental health and substance use.
The new model seeks to improve the quality of behavioral health care while integrating physical health care and other services into behavioral health settings. It focuses on building capacity for behavioral health specialty care practices, while offering a way for them to engage with an alternative payment model designed specifically for mental health and substance use. When treated in an IBH model, patients can expect:
- tailored treatment provided by a multidisciplinary care team, which might include a case manager, peer support specialist, primary care provider, and community-based organization
- physical health screenings and care planning and coordination to address physical health and behavioral health needs together
- identification of drivers of health needs and support in accessing services from community-based organizations
- greater use of telehealth and other technologies to promote behavioral and physical health inside and outside the clinical setting.
CMS and states will work together to fund infrastructure, including health information technology and telehealth capabilities, and address some of the key challenges behavioral health providers face in APMs.
States will design their own Medicaid APMs that meet the needs of providers, while CMS will offer Medicare payments that reinforce the APM design. In many states, these models will be implemented in partnership with Medicaid managed care organizations.
If successful, the model will enable behavioral health practices to meaningfully participate in the future of value-based payment. It also may enable general APMs, like ACOs, to address behavioral health more effectively in the future, because behavioral health specialty care providers will be better equipped to participate.
Other Ways States Can Build Behavioral Health Infrastructure
The IBH model builds on other federal opportunities for states to build their behavioral health infrastructure. In 2018, CMS issued guidance about using Medicaid demonstrations to invest in infrastructure for behavioral health practices, including information technology and other practice changes needed to integrate physical health care. The Substance Abuse and Mental Health Services Administration and the Office of the National Coordinator for Health Information Technology are collaborating to make millions of dollars available to states to invest in behavioral health data integration. Other programs also offer opportunities to build core infrastructure and redress historic underinvestment.
States can continue to build on these investments and encourage behavioral health providers to participate in APMs by using the IBH model. With an investment in infrastructure, behavioral health specialty care providers can participate in payment models that can help improve overall health and well-being for people with behavioral health conditions.
