Brief Description
- Crosswalk tasks needed for effective integrated care to existing payment codes.
- Identify which codes, not currently being paid, need to be activated consistently in support of integrated care.
- Identify which tasks will require new codes to be defined and adopted.
- Define new, flexible payment mechanisms to support and promote scalable adoption of integrated behavioral health.
- This will include layered payments (e.g., bundled home pilots have 3 layers – fee-for-service, care management case rate, quality bonuses, gain sharing between mental health/medical funding sources).
- This will include Medicaid, Medicare, dual-eligibles, and privately insured.
- Define standards for performance/outcome measurement that can be linked to payment and/or financial incentives. Specific initial ideas include:
- separate evaluation of accountable care organizations and medical homes for services delivered to special populations, and,
- consider risk adjustment approach for high need populations.
Opportunity (Why Now?)
- ACO regulations are in process. ACOs are potential organizations for pilot studies.
- There are models for PCMH payment and for payment for collaborative care for common mental disorders such as depression (e.g., DIAMOND), but need to integrate (? Merge) the concepts and payment approaches.
- Investments on the MH/SU side can impact/reduction in healthcare costs
- Healthcare home, other pilots could test new funding models (e.g., 2703 projects, state dual-eligible projects).
Partners
