Create new payment models to further care integration
Recommendation
The Centers for Medicare and Medicaid (CMS) should create novel payment models and build on existing models that allow primary care providers to cover the full range of primary care and mild to moderate mental health and substance use disorder (MH/SUD) services.[1]
Background/summary
Over the past two decades, there has been increasing interest and movement towards value-based healthcare models, including the implementation of new payment reforms and demonstration programs. One of the main goals of value-based care is to move away from a fragmented fee-for-service model of delivering and paying for care to a more holistic system focused on health outcomes, including quality and cost.
New value-based care models can be used to drive further integration of primary care and MH/SUD services. Specifically, Congress should authorize CMS to create and offer the Integrated Health Model as a voluntary option for primary care providers currently in traditional fee-for-service Medicare.[1] Under such a program, risk-adjustment payments would be made to healthcare providers for primary care and integrated MH/SUD services, including preventive physical care, prevention, and management of mild to moderate MH/SUDs, and stress-related physical symptoms.[1]
While new value-based payment models are needed to help speed integration, building on existing models should also be considered. Medicare’s Merit-based Incentive Payment System (MIPS) is designed to improve care and health outcomes by tying payments to a provider's performance.[2] Healthcare providers can have their reimbursements adjusted upwards or downwards based on their performance in four categories: quality, cost, promoting interoperability, and improvement activities.[1] MIPS already includes some MH/SUD measures under the category of improvement activities, including activities related to integration (e.g., completion of a collaborative care management training program). To accelerate further integration, CMS should include additional MH/SUD integration measures in the MIPS mental/behavioral health measure and improvement activity set.[1]
citations
1. Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. Last Updated March 2021.
2. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Quality Payment Program. Traditional MIPS Overview. Last Accessed August 4, 2023.