Some payment reform initiatives have focused on adapting the current fee-for-service structure to allow billing and reimbursement of services that are key to the integrated model of care. In particular, the Centers for Medicare & Medicaid Services (CMS) has recently made several changes to Medicare, noted in a summary of the CMS Final Rule for 2017 Medicare Payments for Integrated Behavioral Health Services (PDF - 154.85 KB) and a related CMS press release.
Despite these improvements, the fee-for-service reimbursement model does not fully address fragmentation and may perpetuate policies that often separate payment of services into two categories: physical and mental. This separate payment structure often forces clinicians to work within their professional silos to receive payment.8 Our health care system needs payment structures that bridge fragmentation in care.
Alternative payment models (APMs) supplement or replace the traditional fee-for-service payment model to focus more on outcomes and quality, and less on the volume of services provided.10 A variety of APMs have been proposed, including global payments, bundled payments, and pay for performance. It is important to understand how various APMs may influence delivery of integrated services11; several informative articles address this topic.10, 12
The Patient Protection and Affordable Care Act placed greater emphasis on primary care, behavioral health, and payment reform. This change in focus was supported by strong data showing that the failure to provide whole-person care to patients with comorbid behavioral health and medical conditions has been a major driver of increasing health care costs. There is growing recognition that integrating behavioral health in primary care leads to better care and improved outcomes. Whatever happens in future health care redesign efforts, integrating behavioral health and primary care can help improve quality and reduce growth in costs.