CMS announced it is launching a new project called the Integrated Care for Kids (InCK) Model that looks to combat the country's opioid epidemic and increase behavioral health access for children.
The agency said the plan is a child-centered local service delivery and state payment model that looks to cut costs and improve the quality of care for those covered by Medicaid and the Children's Health Insurance Program (CHIP).
Critical parts of the model include prevention, early identification and addressing behavioral health challenges and physical health needs. The model will rely heavily on a framework of "care integration across behavioral, physical and other child providers," CMS said.
The new model aims to tackle serious issue for grade schoolers and teens in the U.S. About one in three children in Medicaid and CHIP have behavioral health needs, but only one-third of them actually receive necessary behavioral healthcare. Also, drug overdoses have become more common among adolescents, and more than half of them were caused by opioids in 2015.
CMS hopes InCK can improve child health, reduce avoidable inpatient stays and out-of-home placement and create sustainable alternative payment models. The new program requires states to create APMs that support care coordination, case management, mobile crisis response and stabilization services through existing state authorities under Medicaid or CHIP.
An important piece for successful APMs is having states and local providers share accountability for cost and outcomes. Programs will need to show that accountability, as well as a way to ensure the model's sustainability over the long term. Participants will also need to integrate care coordination and case management across physical and behavioral health as well as local service providers.
CMS will award up to eight states with $16 million each to establish the program over seven years. Awardees can be either a state Medicaid or a lead organization. The agency expects to release a Notice of Funding Opportunity this fall to solicit applications. The seven-year timeframe for states includes a two-year pre-implementation period and five-year model implementation period.
A Milliman research report earlier this year found that delayed and avoided behavioral care led to $406 billion in added healthcare costs in 2017. Behavioral health integration is seen as a way to improve overall health and lower costs, though that's often easier said than done.
One program that has shown success is the collaborative care model, which integrates behavioral health into primary care. It's a primary care-based care manager program that includes a consulting psychiatrist and internist to review care of patients with depression. Roger Kathol, president of Cartesian Solutions in Burnsville, Minnesota, recently told Healthcare Dive the model breaks even in about a year and saves money over the next three years.