The behavioral health sector in the United States is at a pivotal moment. According to Tequila Terry, group director of state innovation and prevention and population health at the Center for Medicare & Medicaid Innovation (CMMI), the sector “is ripe with opportunities to improve.” Speaking at the Behavioral Health Business VALUE event, Terry emphasized that the Biden administration’s continued focus on mental health and addiction treatment, along with the CMS behavioral health strategy, is opening doors for innovation, policy changes, and model development aimed at better care delivery and improved outcomes.
CMMI, which operates under the Centers for Medicare & Medicaid Services (CMS), is exploring ways to integrate behavioral health more fully into its models. “We are thinking about both the opportunity to focus specifically on behavioral health models as a potential design, … and focusing on the opportunity to incorporate behavioral health in our models that are not particularly behavioral health-focused but have people who could benefit from incorporating those elements,” Terry said. While specific timelines remain unclear, her comments highlight that behavioral health is becoming a priority at the highest levels of federal health policy.
Exploring New Models and Opportunities
CMMI has historically been at the forefront of developing innovative care models, often piloting value-based initiatives to improve quality and reduce costs. Terry explained that the agency is now looking to expand these efforts into behavioral health. This may include creating models dedicated entirely to mental health and substance use treatment, as well as incorporating behavioral health elements into broader programs where they can improve patient outcomes.
“We are going to be looking at where our authority can come into play to improve access, to improve outcomes, and really to focus on creative and innovative ways to engage providers who frankly haven’t been a part of the value-based movement,” Terry said. Engaging providers who have previously been excluded from value-based initiatives could allow CMMI to address gaps in care and reach populations that have historically struggled to access behavioral health services.
Data-Driven Approaches to Behavioral Health Outcomes
Outcomes measurement is central to CMS’ behavioral health strategy. Terry highlighted a collaborative, data-driven approach that spans across the U.S. Department of Health and Human Services (HHS) and CMS. The recently formed data coordinating council will evaluate metrics related to disparities, access to care, hospital and crisis service utilization, and other key outcomes for individuals with behavioral health needs.
“The council will define what specific outcomes we want to measure,” Terry said. By analyzing data across Medicare, Medicaid, CHIP, and other programs, CMS is uniquely positioned to gain insights into diverse populations, including underserved communities and high-risk groups. The CMS behavioral health strategy ensures that future behavioral health models are informed by real-world evidence and can be tailored to meet the needs of different populations effectively.
Early Engagement with Industry Stakeholders
Traditionally, CMMI designed new models internally before consulting with external stakeholders. Terry noted a significant shift in this approach, emphasizing early engagement with behavioral health experts and providers. The agency plans to host listening sessions and collaborative forums to gather input before finalizing model designs.
“So what we want to do as we move forward is to host listening sessions and engage with organizations … so we can get your input earlier in the design process,” Terry explained. This collaborative approach aligns with the broader goals of the CMS behavioral health strategy, ensuring that innovative models are feasible, effective, and responsive to real-world provider and patient needs.
Advancing Health Equity Through Medicaid
Medicaid remains the largest payer for mental health services in the United States, yet members often face barriers to accessing care. Terry highlighted the Biden administration’s commitment to equity, stressing that new payment models must reach all populations fairly.
“If our goal is to focus on improving health equity, we have got to have a more equitable reach across all the populations,” Terry said. The CMS behavioral health strategy, released in April, emphasizes integrating health equity into care and payment models, particularly for populations at risk for poor behavioral health outcomes. Programs like the Maternal Opioid Misuse (MOM) model exemplify this focus, providing comprehensive services for both mothers and infants that address physical and behavioral health needs.
Terry also noted that CMS is working to ensure Medicaid beneficiaries benefit from care transformation initiatives and payment reforms, reflecting a broader push to close gaps in access and outcomes. This approach is central to the CMS behavioral health strategy, which aims to improve care delivery while addressing disparities in underserved communities.
Collaboration with States and Community Providers
CMMI is committed to working closely with states and community providers to address unmet behavioral health needs. Terry emphasized that states possess unique authority to engage beneficiaries in ways that can improve cost and quality outcomes. By partnering with states, CMS can ensure that new models are meaningful, practical, and scalable.
Community engagement is another cornerstone of the strategy. Terry explained that leveraging local resources, conducting screenings for social needs, and supporting community-based interventions can enhance care delivery and provide more comprehensive support for individuals with behavioral health challenges.
“We think there are a lot of opportunities to engage community resources, to provide services, to do screenings of social needs,” Terry said. By connecting individuals to these resources, CMS hopes to reduce barriers to care and improve overall population health. These initiatives are a key part of the CMS behavioral health strategy, which emphasizes collaboration between federal, state, and community partners.
Looking Ahead: Innovation, Collaboration, and Impact
While the rollout of new models remains in the exploratory phase, the direction is clear. CMS and CMMI are focused on innovation, stakeholder engagement, equity, and data-driven outcomes to transform behavioral health services in the United States. By creating inclusive, effective, and measurable programs, the agency aims to improve access, outcomes, and quality of care for mental health and substance use treatment nationwide.
The CMS behavioral health strategy signals a new era for behavioral health in the U.S., with more integrated approaches, stronger alignment between public and private sectors, and innovative models that address both clinical and social determinants of health. Providers and stakeholders now have an unprecedented opportunity to help shape the future of behavioral health care.
