On December 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the selection of Michigan, New York, Oklahoma, and South Carolina state Medicaid agencies to participate in the Innovation in Behavioral Health Model (IBH). This initiative, which begins implementation on January 1, 2025, aims to enhance care integration for Medicaid and Medicare beneficiaries with moderate to severe mental health conditions and substance use disorders (SUD).

The Behavioral Health Model

The IBH Model focuses on improving access to coordinated, person-centered care by addressing both behavioral and physical health needs, along with health-related social needs (HRSN) such as housing and food insecurity. It emphasizes collaboration between behavioral health providers and other healthcare professionals. Participating practices will screen, assess, treat, and refer patients as necessary, utilizing interprofessional care teams to support comprehensive care management.

Key features of the model include:

1. Care Integration: Practices will bridge the gap between behavioral and physical health through screenings, treatment, and referrals.
2. Health Equity: Practices will develop health equity plans to address disparities and annually screen for HRSNs.
3. Care Management: Behavioral health providers will coordinate ongoing care and support patients’ multifaceted health needs.
4. Health IT Expansion: Investments in health information technology will improve data sharing and quality reporting.

The initiative is state-led, with states recruiting specialty behavioral health practices, including community mental health centers and opioid treatment programs, to participate. Oklahoma will implement the model statewide, while Michigan, New York, and South Carolina will focus on specific regions. The program includes both Medicaid and Medicare-aligned payment approaches, with funding tied to performance and quality outcomes.

This eight-year initiative supports CMS’ broader goals of promoting health equity, reducing healthcare fragmentation, and improving outcomes for vulnerable populations. It prepares participating practices for advanced payment models and accountable care arrangements in the future.

Similarities and Differences between the IBH, BHH and CCBHC Models of Care

The Innovation in Behavioral Health (IBH) Model, Behavioral Health Home (BHH) Model, and Certified Community Behavioral Health Clinic (CCBHC) Model share a common goal of improving behavioral health care, but they differ in their design, implementation, and focus areas. Here’s a breakdown of the key differences:

1) Model Purposes and Scope

• IBH Model:
  • Focuses on integrating behavioral and physical health for Medicaid and Medicare populations, including those with moderate to severe mental health conditions or substance use disorders (SUD).
  • Aims to align payment approaches between Medicaid and Medicare to support value-based care and improve care coordination.
  • Emphasizes addressing health-related social needs (HRSNs) such as housing, food insecurity, and transportation.
• Behavioral Health Home (BHH) Model:
  • Primarily serves individuals with serious mental illness (SMI) or SUD by integrating primary care into behavioral health settings.
  • Focuses on managing chronic physical conditions alongside behavioral health needs, particularly for high-risk populations.
  • Provides a holistic, patient-centered approach that includes health promotion and prevention.
• CCBHC Model:
  • Offers a comprehensive range of behavioral health services to anyone seeking care, regardless of ability to pay or insurance status.
  • Focuses on timely access to services, including crisis mental health care, outpatient treatment, and primary care screening.
  • Aims to transform community-based clinics into hubs for integrated behavioral health services.

2) Payment and Financial Models

• IBH Model:
  • Uses value-based payment mechanisms, including performance-based incentives tied to quality and outcomes.
  • Incorporates Medicaid and Medicare-aligned payment approaches, such as per-member-per-month payments supplemented by performance-based rewards.
• Behavioral Health Home Model:
  • Often uses a per-member-per-month payment structure to support care coordination and management activities.
  • Focuses on reimbursing providers for coordinating care and managing chronic conditions.
• CCBHC Model:
  • Operates under a Prospective Payment System (PPS), which provides a fixed payment per visit or per month to cover the costs of delivering comprehensive services.
  • Emphasizes financial sustainability for clinics to ensure access to a broad array of services.

3) Target Populations

• IBH Model:
  • Serves Medicaid and Medicare beneficiaries with moderate to severe behavioral health conditions, including those who are dually eligible.
  • Specifically targets individuals with unmet behavioral, physical, and social health needs.
• Behavioral Health Home Model:
  • Focuses on individuals with serious mental illness (SMI) or SUD, often those with co-occurring chronic physical health conditions.
• CCBHC Model:
  • Serves all individuals seeking care, including uninsured, underinsured, and insured populations.
  • Designed to improve access to care for marginalized and underserved populations.

4) Care and Delivery Coordination

• IBH Model:
  • Relies on specialty behavioral health practices leading interprofessional care teams to provide integrated care.
  • Addresses both behavioral and physical health needs alongside HRSNs through screenings, treatment, referrals, and ongoing monitoring.
• Behavioral Health Home Model:
  • Uses a patient-centered medical home approach within behavioral health settings to provide primary care services alongside mental health and SUD treatment.
  • Focuses on ongoing care management for chronic conditions and promoting health and wellness.
• CCBHC Model:
  • Provides a full spectrum of behavioral health services, including crisis intervention, outpatient therapy, medication-assisted treatment, and peer support.
  • Prioritizes quick access to care and comprehensive service delivery at the community level.

5) Health Equity and Social Determinants of Health

• IBH Model:
  • Includes a health equity plan requirement for participating providers, addressing disparities and unmet social needs through annual screenings and referrals.
  • Actively integrates social determinants of health into care delivery.
• Behavioral Health Home Model:
  • Addresses health equity through tailored care plans and a focus on managing chronic conditions that disproportionately affect vulnerable populations.
• CCBHC Model:
  • Designed to ensure access to care for all individuals, especially those from underserved and high-risk communities.
  • Does not have a formal health equity plan requirement like IBH but inherently focuses on reducing disparities through access.

Summary of Differences

Target Population	Medicaid/Medicare; moderate to severe mental health/SUD	SMI/SUD; high-risk populations	All individuals seeking behavioral health care
Care Approach	Integrated care for behavioral, physical, and social health needs	Focus on chronic disease management and health promotion	Comprehensive behavioral health care
Payment Model	Value-based; Medicaid/Medicare-aligned payments	Per-member-per-month for care coordination	Prospective Payment System (PPS)
Health Equity Focus	Formal health equity plans; screens for HRSNs	Addresses disparities through chronic care management	Prioritizes access for underserved populations
Service Scope	Behavioral and physical health integration	Behavioral health with integrated primary care	Full spectrum of behavioral health services

These models can complement each other to address the complex needs of individuals requiring behavioral health services, with each offering unique strengths to improve health outcomes and equity.  Accreditors such as TJC, CARF, and COA have Accreditation and/or Certification standards that support high quality IBH, BHH, or CCBHC care delivery.

Barrins & Associates

Barrins & Associates can assist you to develop and implement a high quality IBH, BHH, or CCBHC program in accordance with TJC, CARF, or COA applicable standards. Contact us today to learn more about our services.

Barrins & Associates – “Empowering Healthcare Excellence Together”