Expand value-based payments to encourage care integration
Recommendation
Congress should require the Centers for Medicare and Medicaid Services (CMS) to conduct an analysis of integration models in Medicaid and publish guidance describing state options for adopting or expanding value-based payment arrangements that integrate mental health or substance use disorder (MH/SUD) care within the primary care setting and best practices.[1][2][3]
Background/summary
Value-based payment systems are designed to improve patient care with financial incentives to providers, and such programs have been successfully implemented by the Centers for Medicare and Medicaid Services (CMS) for several programs aimed at reducing hospital-acquired illnesses and readmissions.[4] By incorporating mental health and substance use disorder (MH/SUD) care within primary care settings and expanding value-based payment models that tie quality metrics to payment, it can align incentives to improve the quality of care and outcomes.[3] In its 2022 Mental Health Care Integration Discussion Draft, the Senate Finance Committee proposed requiring CMS to analyze Medicaid integration models and deliver guidelines for states to incorporate value-based payment arrangements integrating MH/SUD and primary care.[1][2][3]
citations
1. U.S. Senate Committee on Finance. Bipartisan Mental Health Care Provisions. Last Updated November 10, 2022.
2. U.S. Senate Committee on Finance. Finance Committee Unveils Mental Health Care Integration Discussion Draft (Press Release). Last Updated November 10, 2022.
3. The Kennedy Forum. Quality & Parity: New Payment Models for Behavioral Health. Last Updated September 8, 2017.
4. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. What are the value-based programs?. Last Updated March 31, 2022.