Develop quality measures to assess care integration
Recommendation
Congress should require the Centers for Medicare and Medicaid Services (CMS) to develop Medicare quality measures that assess the degree to which clinician practices integrate mental health and substance use disorder (MH/SUD) and primary care.[1]
Background/summary
Despite effective MH/SUD treatments being widely available, many individuals with MH/SUD do not receive needed treatment, in part due to historically siloed MH/SUD and physical health systems.[2] Integrating MH/SUD and physical health services is essential to improving access to care, as well as patient outcomes.[2] In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician practitioners for supplying patients with Behavioral Health Integrated Services (BHI).[3] These services involve a closer partnership between providers, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM). This model has been demonstrated effective by more than 90 randomized-controlled trials and can help to utilize limited MH/SUD provider capacity more effectively.[4]
Quality measures are used by CMS to measure and track a range of outcomes and processes in order to determine the ability to provide effective, timely, safe, efficient, patient-centered, and equitable care based on related quality goals.[5] There are currently no quality measures tied to quantifying or monitoring the degree to which clinical practices integrate MH/SUD.[6] Congress should pass language included in the Senate Finance Committee’s 2022 Mental Health Care Integration Discussion Draft, which would require CMS to develop Medicare quality measures that assess BHI efforts undertaken by clinical practices.[1][7]
citations
1. U.S. Senate Committee on Finance. Bipartisan Mental Health Care Provisions. Last Accessed November 10, 2022.
2. The Kennedy Forum. Vision: Integration. (n.d.)
3. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Behavioral Health Integration Services. Last Updated March 2021.
4. The University of Washington AIMS Center. Collaborative care. (n.d.)
5. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Quality Measures. Last Updated April 14, 2022.
6. Mental Health Care Integration and Crisis Care Improvement Act. Discussion Draft. (Wyden-Cornyn). Last Accessed 2022.
7. U.S. Senate Committee on Finance. Finance Committee Unveils Mental Health Care Integration Discussion Draft. Last Accessed November 10, 2022.