Behavioral Health Integration for Medicare Members

Around 1 in 4 individuals enrolled in Medicare experience some form of mental illness. Therefore, a new program, called Innovation in Behavioral Health (IBH) Model, was recently announced by the Centers for Medicare and Medicaid Services (CMS) to improve outcomes for those with mental health issues and substance use disorders (SUDs). The IBH Model will direct Medicare and Medicaid enrollees to various mental, physical, and social care and resources.

Please note, this program will launch in the fall and run for eight years in eight states selected by the  CMS.

Care teams will be formed with behavioral and physical health providers, and the CMS plans to allow collaboration between primary care and other physical health providers to allow for more holistic and well-rounded outcomes. Members seeking care will be directed to the proper care no matter how they first seek out care.

With a value-based approach, practice participants will be compensated based on the quality of care provided and patient outcomes. CMS’s IBH Model aims to improve care in four areas: care integration, care management, health equity, and health information technology.

Care integration will focus on increased access to screenings, assessments, referrals, and treatment for behavioral health patients.

Care management allows a participating behavioral health professional and their team of interprofessionals to identify patients’ needs and provide care.

Health equity ensures that patients will be screened for health-related social needs and referred to accessible community-based services.

Health information technology will experience an expansion through targeted investments in interoperability and tools to help participants evolve their reporting and data sharing.


As more information is made available, Creative Benefits will release updates.