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Understanding the Impact of CMS’s New Making Care Primary (MCP) Model on Substance Use Recovery Providers

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The Centers for Medicare and Medicaid Services (CMS) recently introduced the Making Care Primary (MCP) Model, an initiative built to integrate substance use and behavioral health into primary care, as well as adapting payment and delivery methods for value-based care over 10.5 years. This blog post explains the impact of the MCP Model on substance use recovery providers, shedding light on the changes, challenges, and opportunities they may encounter.

The 8 states that will test this model are:

  • Colorado
  • Massachusetts
  • Minnesota
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • Washington

What is the MCP Model?

The MCP model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs. Access to high-quality primary care is associated with better health outcomes and equity for people and communities. MCP is an important step in strengthening the primary care infrastructure in the country, especially for safety nets and smaller or independent primary care organizations.

What Are the Goals of Integrated Behavioral Health Care?

  • Ensure patients receive primary care that is integrated, coordinated, person-centered, and accountable.
  • Create a pathway for primary care organizations and practices – especially small, independent, rural, and safety net organizations – to enter into value-based care arrangements.
  • Improve the quality of care and health outcomes of patients while reducing program expenditures.

To achieve these goals, the MCP Model will provide participants with additional revenue to build infrastructure, make primary care services more accessible, and improve care coordination between various specialties. CMS expects the MCP model will lead to downstream savings over time through better preventive care and reducing potentially avoidable costs, such as repeat hospitalizations. 

The Integration of Substance Use Recovery, Behavioral Health, and Primary Care

Integrated care is a treatment model that addresses substance use issues in primary care settings. By providing access to specialized treatment services, providers can help improve client outcomes and reduce the overall harm associated with substance use disorders.

Integrating substance use recovery and primary care is particularly relevant given the opioid epidemic and the increased rates of substance use observed among people living with chronic pain and other medical conditions. By establishing a coordinated and responsive network of care providers, including primary care clinicians, specialists, social service providers, and behavioral health clinicians, patients can benefit from a more holistic approach to health care.

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MCP’s Impact on Substance Use Recovery Providers

The Shift to Value-Based Care

The MCP Model’s goal of incentivizing value-based care arrangements may not align with the traditional fee-for-service model on which many substance use recovery providers rely.  Providers may need to shift their business models and seek reimbursement through value-based care arrangements that incentivize high-quality client care outcomes and meaningful improvement in the health of their clients.

On the other hand, the propensity towards quality client care outcomes in value-based care arrangements could also lead to reimbursement opportunities in substance use recovery interventions, such as medication-assisted treatment and behavioral health integration, that previously were not reimbursable. This shift in reimbursement models can incentivize providers to focus on the long-term recovery and wellness of individuals with substance use disorders rather than just episodic treatment.

One major obstacle to primary care integration is financial. Many substance use recovery or safety net organizations lack the capital to implement this shift effectively. In addition, inconsistent billing and reimbursement guidelines add to provider’s administrative burden and slow down their revenue stream. The MCP’s answer to these obstacles are:

  • Consistent, upfront payments to help providers integrate behavioral health care.
  • Improvement bonuses if depression screenings show depression remissions.
  • More billing options for behavioral health services.
  • Smaller organizations with fewer resources can take the financial risk of participating in the MCP model incrementally.
  • Additional funding for care integration and coordination.

Care Integration and Coordination

Collaboration through coordinated care, data sharing, and interdisciplinary teamwork can significantly improve patient outcomes. Through integration, providers can focus on quality, cost-effective care that emphasizes the patient’s overall health and well-being. Substance use recovery providers can leverage existing relationships with clients and community-based organizations to improve medication adherence and long-term recovery outcomes.

One of the main benefits of care coordination, data sharing, and interdisciplinary collaboration is the alignment of care goals among different medical professionals working with patients with substance use disorders. This helps to reduce duplicative efforts and improves communication among providers, restoring continuity of care and preventing gaps in care. Improved care coordination also helps promote client engagement, enabling better access to the right medical care, improved self-care and adherence, and client satisfaction. Nevertheless, interoperability presents a significant challenge regarding data sharing and effective communication among providers. To overcome these challenges, more work is needed to build a robust data-sharing infrastructure.

Integrating substance use recovery providers with primary care providers requires changes in care management processes and workflows, including developing a care process model that incorporates individuals with substance use disorders. This involves cross-training between professionals, improved data management systems, and specialized substance use management team support. Substance use recovery agencies need to adapt their workflows to include referrals and establish robust data sharing to send and receive data to providers from other specialties. That means using interoperable EHRs that allow data from different specialties to map out the full care journey.

Quality and Performance Measures

Under the MCP Model, substance use recovery providers will be expected to meet certain quality and performance measures to demonstrate their commitment to delivering high-quality care. These measures may include indicators such as reduced substance use, improved treatment engagement rates, increased retention rates in treatment programs, improved mental health outcomes, and reduced overdose rates. Providers will need to track and report on these measures to assess their performance and demonstrate their ability to achieve positive outcomes for their clients. Compliance with these quality measures may be necessary for receiving reimbursement and participating in value-based care arrangements.

Outcome-based metrics and improved patient experience are crucial components of the MCP Model. By focusing on outcomes, substance use recovery providers can assess the effectiveness of their interventions and treatments and make necessary adjustments to improve client outcomes. Outcome-based metrics provide a clear picture of the impact of the care delivered and help providers identify areas for improvement. Improved client experience, including factors such as access to care, communication, and client satisfaction, is essential to ensuring patient engagement and retention in treatment programs. By putting clients at the center of their care, substance use recovery providers can enhance their patients’ overall experience and increase their likelihood of achieving successful recovery.

Non-compliance with established quality measures can have significant implications for substance use recovery providers. It may result in financial penalties, loss of reimbursement, and exclusion from participation in value-based care arrangements. Non-compliance can also negatively impact the provider’s reputation and credibility, potentially losing clients and referral sources. Additionally, non-compliance may indicate suboptimal care or failure to achieve positive patient outcomes, eroding trust and confidence in the provider’s ability to treat substance use disorders effectively. Compliance with quality measures is crucial for financial sustainability and ensuring the delivery of high-quality, effective care to clients with substance use disorders.

Challenges and Potential Solutions

The MCP Model offers substance use recovery providers the potential to enhance their practice by increasing access to resources, support, and collaboration, improving patient outcomes through coordinated care, and expanding treatment options. By embracing the model, providers can improve the overall quality of care and outcomes for individuals affected by substance use disorders. Nonetheless, Implementing the MCP Model in substance use recovery settings may come with some challenges. Here are a few that providers might encounter:

  • Cultural and organizational change: Shifting to a model that emphasizes integration, coordination, and reporting requirements may require significant changes in organizational culture and workflows. This change can be met with resistance from staff members who may be unfamiliar with or resistant to change. Developing a clear implementation plan, providing adequate training, and engaging staff in the process can help address these challenges. Open communication and involving staff in decision-making can help foster buy-in and collaborative problem-solving.
  • Data management and reporting: The MCP Model emphasizes data collection, reporting, and performance metrics. Substance use recovery providers may face challenges in implementing data management systems and ensuring accurate reporting. Investing in an EHR that meets the reporting requirements, providing training on data collection and entry, and using standardized protocols can help overcome these challenges. Collaborating with other stakeholders, such as state agencies or healthcare technology vendors, can provide additional support in data management and reporting.
  • Integration and coordination with primary care providers: Coordination and collaboration with primary care providers may be new for substance use recovery providers. Establishing lines of communication, protocols for information sharing, and developing joint care plans can address these challenges. Regular meetings, case conferences, and shared training opportunities can enhance collaboration and integration. Regular communication and building relationships with primary care providers can facilitate effective care coordination.

To overcome these challenges, it is vital for CMS and other stakeholders to provide ongoing support, education, and resources to substance use recovery providers. Regular communication and updates from CMS can help clarify requirements, address any ambiguities, and provide guidance on implementation. Offering educational resources, training programs, and technical assistance can support providers in understanding and meeting the MCP Model requirements. Stakeholders can also facilitate peer learning and promote networking opportunities for providers to share best practices and lessons learned.

Emphasizing the importance of communication, education, and ongoing support from CMS and other stakeholders is crucial to help substance use recovery providers successfully implement the MCP Model. By addressing challenges and providing the necessary resources, substance use recovery providers can effectively adapt to the model and improve care delivery for individuals with substance use disorders.

The CMS Making Care Primary (MCP) Model represents a significant shift in the healthcare landscape. Understanding the financial, organizational, and operational changes brought about by the MCP Model is crucial for behavioral health providers to adapt, thrive, and continue to offer effective care for individuals struggling with substance use disorders.

By recognizing the opportunities and challenges presented by the MCP Model, substance use recovery providers can navigate this evolving landscape and contribute to improving patient outcomes and addressing the nation’s addiction crisis. Substance use recovery providers should proactively engage with the initiative, stay informed about its developments, and seek opportunities for collaboration to maximize the positive impact on individuals and communities affected by substance use disorders.

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