The Innovation Center at the Centers for Medicare and Medicaid Services (CMS) is tasked with piloting new models that shift away from paying for the volume of health care services provided and toward value. This past spring, the Innovation Center released its new strategic direction for President Trump’s second term.
To be successful, this strategy must be built on a foundation of access to affordable coverage. After the passage of the reconciliation bill in 2025, millions of people risk losing health insurance coverage under Medicaid and the individual marketplaces. CMS must work with states to ensure that people retain their health insurance coverage. Health insurance coverage provides the critical engine for the new strategic direction to improve long-term health outcomes and drive down overall costs.
The Innovation Center has a critical opportunity to advance behavioral health in the United States by:
1. Promoting evidence-based prevention.
Decades of evidence finds that early intervention improves a range of behavioral health outcomes, and that behavioral health conditions may be prevented by acting early in some cases. For example, if primary care providers offer a few therapy sessions when people experience the first signs of mental health distress or substance use, they may be able to preempt a diagnosable behavioral health condition.
To date, only a small proportion of people have access to these services, given limited preventive coverage in behavioral health. Even when it is covered, there are limited incentives for implementing interventions and payments may not cover the costs. The Innovation Center has the opportunity to support providers in building capacity to offer preventive services, like limited therapy sessions, as part of regular primary care. The Center can also reward providers for delivering effective prevention in behavioral health, which can help to drive down overall costs.
2. Empowering people to achieve their health goals.
The Innovation Center seeks to make sure people have more information when making choices about their care, while aligning providers’ financial incentives with care outcomes. Some existing payment models already measure and reward providers for managing their patients’ depression symptoms. Other measures have been developed that go beyond depression symptoms, but they have not yet been implemented in federal programs. One that could be considered in the future is goal attainment scaling, a way of measuring whether people are reaching the goals they set for themselves in their care.
The Innovation Center can support health care providers in adopting quality measures that focus on what matters most to patients. For example, the Center can incentivize uptake of an existing measure that focuses on how well people with a range of behavioral health conditions feel able to function in their daily lives. It can also make these data transparent to consumers to inform decision-making around providers and plans. By tying payment to performance on these measures, the Center can further support providers in focusing on outcomes.
3. Driving choice and competition.
The Innovation Center seeks to engage more independent practices in payment reforms and improving connection with community-based organizations. Engaging independent practices will be critical for behavioral health. Approximately 41 percent of psychologists work in solo practices and, thus far, small providers have had difficulty participating in payment models. The Center can pursue models that provide up-front financing and technical assistance for behavioral health providers, ensuring they have the necessary information technology, practice workflows, and financial management to be successful.
Community-based organizations currently play a major role in behavioral health care and could have a much larger impact if effectively engaged. For example, one strategy, known as the “clubhouse” approach, provides a place where people with serious mental illnesses can gather for social support and other resources. These places may help to improve outcomes and reduce total costs but are not engaged in the formal care system. Bringing more of these community-based based approaches into the Center’s models would extend the reach and impact of the limited clinical behavioral health workforce.
Making the Strategy Successful for Behavioral Health
Because behavioral health providers do not receive Medicare payments for adopting electronic health records, many need additional investment to meet the information technology demands of the models proposed by the Innovation Center. They may also not be ready to take on financial risks, as many providers are small or operate on extremely thin margins. With integration of behavioral health and primary care so limited, models will need to acknowledge additional up-front costs associated with capacity building that can result in later savings.
If the Innovation Center builds on a foundation of affordable and accessible insurance coverage and care, this new strategic direction can address some of the fundamental issues facing behavioral health care in the U.S., while aligning incentives for better outcomes at lower long-term costs.
