Identify best practices for value based payments

Given the chronic and complex nature of MH/SUDs, fee-for-service payments continue to present challenges to improving quality and outcomes in our systems. Individuals with MH/SUD often need a variety of services across a continuum that, in today’s system, are largely not economically linked and are being reimbursed in fragmented inefficient pathways. There is a tremendous need to integrate MH/SUD and physical health outcomes in model design to produce overall value for the health system.

Though numerous MH/SUD VBP models are ongoing across the country, CMS could play an important role in helping identify best practices, barriers to adoption, and solutions to overcome them. For example, a number of VBP models for SUD are being piloted in states across the country and are being tracked by the Alliance for Addiction Payment Reform.[1] By increasing the visibility of promising payment models and how to address common barriers, CMS can help providers and public and private payers with best practices and seed additional innovation.

Therefore, Congress should direct CMS to issue a VBP model report. Key information that CMS should be required to report include: Current market adoption of MH and SUD market adoption; best practices, barriers, and potential solutions for using VBP models to drive long-term value for MH and SUDs, including key outcomes measures; and state-by-state analysis of the differences in furnishing MH and SUD VBP models that examine utilization and retention rates, program costs and total costs of care, avoidable negative outcomes (e.g., inpatient admissions), quality of care, and patient, family, and provider satisfaction.

CMS should also be required to issue guidance to States regarding the adoption of VBP models for MH/SUD treatment and recovery services in Medicaid. The guidance should include State options for using VBP models in Medicaid 1115 waivers, state-directed payments, in lieu of services, contracts with managed care entities, and provide specific guidance for best practices to States that carve out MH/SUD services.