Create a care funding pool for IPAs and VBP models

In most fee-for-service payment models for mental health and substance use disorder (MH/SUD) care, providers and payers are unable to control or directly influence all facets of a person’s recovery journey, including the various manifestations of recovery disruptions. In recent years, both public and private payers have increasingly introduced payment demonstrations designed to promote improved integration of disparate parts of the delivery system to foster improved collaboration and efficiency. Transitioning to value-based payment (VBP) models from the traditional fee-for-service model requires significant restructuring of incentives to encourage collaboration, record sharing, and outcome tracking.[1]

However, the infrastructure required to do this for existing providers is lacking.[2] There is a need for a care transformation funding pool that can support providers to develop Independent Practice Associations (IPA)[3], or other network structures to act as local market organizers of disparate elements of the existing care continuum, provide care coordination to the targeted beneficiaries, and shore up technology gaps in the region to support patient retention and track outcomes across specific care sites. An IPA can provide a single point of engagement for Medicaid managed care organizations and commercial payers across a focused geographic area. These entities can provide shared administrative services, offer increased numbers of beneficiaries to payers, and provide critical quality measurement and data reporting functions foundational to support value-based care.

Such a funding pool could be administered by the Centers for Medicare and Medicaid Services (CMS) through grants or as part of a “meaningful use” type incentive payments to IPAs that create the infrastructure necessary for VBP model contracting. The “meaningful use” model was used by CMS previously to give incentive payments for improvements in provider infrastructure specifically to adopt electronic health records. This model could be targeted at MH/SUD providers to bring together disparate providers to work together in local markets to advance VBP opportunities.[4]