The Future of Financing Mental Health and Addiction Services

For chronic illnesses that need to be managed over time, not solely in acute instances, aligning the payment incentives to overall health and wellness re-orients care away from a fee-for-service volume-based focus. The vast majority of this in the market today is driven by CMS through the Medicare Accountable Care Programs, however, commercial insurers have now increasingly moved toward value-based primary care offerings and deploying other condition-specific episodes of care.

Emerging promising examples beginning in behavioral health – A number of new models have recently emerged including the Certified Community Behavioral Health Clinic (CCBHC) model for non-profit mental health and addiction services, the P-COAT model from ASAM for Opioid Use Disorder episodes, and the Addiction Recovery Model Home – Alternative Payment Model (ARMH-APM) for integrated Substance Use Disorder care. Each model provides increased flexibility of payment to the provider in some kind of bundle-based or episode-of-care framework that packages together a more comprehensive set of services along the continuum and frees up the provider to care for an individual and their needs in flexible and independent ways versus the rigidity of independent CPT billing codes.