Increasingly, it seems, the Centers for Medicare & Medicaid Services is grasping the multifaceted health challenges facing older Americans, the value of community-based stakeholders as problem solvers and the importance of social determinants of health as key drivers of health. These keen insights were on display in CMS’ announcement Thursday about the new Innovation in Behavioral Health Model.
The model, which will launch in the fall and run for eight years, targets Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder (SUD). As CMS notes, a quarter of all people enrolled in Medicare experience mental illness, and 40% of all adults enrolled in Medicaid experience mental illness or SUD.
Practice participants will be community-based behavioral health organizations and providers, including safety net providers, and public or private practices, where individuals can receive outpatient mental health and/or SUD services. These entities will lead interprofessional care teams and be responsible for coordinating with other members of the care team to comprehensively address a patient’s care to include behavioral and physical health, and health-related social needs such as housing, food and transportation.
This program is an important development for Medicare and Medicaid, the two major government programs catering to older and sicker adults. Those familiar with this demographic understand the prevalence of behavioral health problems and the cost implications of these problems on the healthcare system — in part through patients’ repeated hospitalizations.
Besides recognizing the need to serve this high-risk population, CMS is smart in recognizing how a patient’s care includes whole-person health — physical, mental and social health involving nutrition and housing. And how various community stakeholders need to work together to attack the problem.
“The systems of care to address physical and behavioral health conditions have historically been siloed, but there is a direct correlation between people with mental health conditions or substance use disorder and poor physical health,” Liz Fowler, CMS deputy administrator and innovation center director, said in a statement. “This model will bring historically siloed parts of the health system together to provide whole-person care.”
It would appear that home care has a part to play in this model.
Liza Berger is editor of McKnight’s Home Care. Email her at firstname.lastname@example.org.