CMS announces its Innovation in Behavioral Health Model

We are delighted to see that the Centers for Medicare & Medicaid Services (CMS) and others are working towards delivering person-centered, integrated care to populations with severe mental illness (SMI) and/or substance use disorders (SUD).

Such innovations are imperative to bridging the gap between behavioral and physical health care nationally.

The IBH Model Focuses on Medicare and Medicaid Populations

Like most CMS initiatives, the IBH Model will be led by state-Medicaid agencies. The IBH Model puts behavioral health providers at the center of care coordination for its patients.  Behavioral and physical health needs, as well as health-related social needs such as housing, food, and transportation will be addressed. Participating providers will be reimbursed based on the quality of care provided and improved patient outcomes. The IBH Model is projected to run for 8 years with a pre-implementation that will fund participants to develop and implement models. The initial roll-out is intended to help prepare practices for more advanced alternative payment models in the future.

NovaWell Demonstrates that Commercial Health Plan Members Also Benefit from Integrated Care

In 2018, the NovaWell team in concert with community mental health treatment organizations and other national subject matter experts developed the model of care now known as the Integrated System of Care. The program pilot officially launched in July of 2019 with a very similar approach for our members. It focused on supporting a   behavioral health driven, integrated care model for commercial members with SMI and SUD in our home market (New Jersey). The pilot was so successful that we quickly agreed to roll it out statewide and have never looked back.

This model, now known as the NovaWell CommunityCare model, put the behavioral health provider at the center of a patient’s care so they were well positioned to “quarterback” that individual's specific needs.  They not only engaged members but worked closely to ensure that they were retained in the program securing a better outcome in their treatment journey. The entire community worked together to ensure that the member’s total health – physical and mental - was considered in treatment planning including social needs which is so crucial to supporting full commitment to treatment, reducing obstacles to care and improving quality of life. .

With over 3,500 Horizon members benefiting from the NovaWell CommunityCare model over the past five years, we have achieved phenomenal clinical and financial outcomes. Members report fewer days of mental health and SUD symptoms and improvement in quality of life. They are also realizing significant reductions in emergency department visits and in-patient stays for both physical health and behavioral health conditions.

Whether insured by Medicare, Medicaid or a commercial plan, every person should have access to the same types and qualities of integrated treatment for SMI and SUD; addressing not only behavioral health, but also physical health and social needs is the cornerstone of effective treatment.

NovaWell commends CMS for their commitment to improving health outcomes and implementing the Innovation in Behavioral Health Model.

NovaWell, an affiliate of Horizon Healthcare Services, Inc., is driving the integration of physical and behavioral health, social needs and pharmacy support both within a health plan and out in the community. We break down the barriers and challenges of stigma and access. As more companies and organizations understand and embrace a truly integrated care model, we will move closer to helping people achieve their best whole health.

To learn more about NovaWell visit www.NovaWell.com

Read more about the IBH model here: https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model.