The need for improved access to mental health and addiction services is accelerating rapidly in the U.S.—particularly among Medicare beneficiary populations, as documented in The State of Mental Health in America, a report released in July 2024 by Mental Health America, a national nonprofit advocacy organization.
Between 2021 and 2022, 23% of adults, or 60 million Americans, experienced a mental illness, and the research found that most struggled with mental issues for more than a decade before receiving help. Regarding substance use disorders, specifically, 18% of U.S. adults grappled with addiction in 2022, and 77% of them did not receive treatment. With nearly 58 million adults living with mental health conditions, the National Institutes of Health (NIH) reports that the most prevalent conditions for adults in the U.S. are anxiety disorders, including panic conditions.
To address this urgent imperative, the Centers for Medicare and Medicaid Services (CMS) introduced the Innovation in Behavioral Health (IBH) Model to improve the quality and integration of care. Included is a new CMS network adequacy evaluation standard that requires networks to offer the correct number of providers that specialize in mental health and addiction issues. As of January 1, 2025, the new regulations require insurers to cover mental healthcare at the same level as other health services—prohibiting health plans from assigning more stringent prior authorization requirements for mental health than for other forms of care. CMS projects a 2.8% increase inpatient rates in 2025. This means payers will need to make fiscal management adjustments to absorb increased systemwide costs.
Other regulatory measures supporting the increasing focus in 2025 include reimbursement for FDA-approved digital therapy that has introduced separate coding and payment for patient safety planning interventions, as well as the Drug Enforcement Administration’s extension of rules allowing prescription of controlled substances through telehealth indefinitely. The need for clinical protocols and resources will grow to support the ongoing treatment of diagnosed mental health and addiction conditions.
As these and other IBH requirements roll out nationwide, the Lightbeam clinical services team can help support your key objectives by augmenting existing resources or serving as a full strategic care management solution. In addition, Lightbeam AI can help synthesize multiple data sources, including social determinants of health (SDOH) to streamline administrative workflows and prioritize rising-risk patient needs in value-based care organizations.
Behavioral health care management is complex, which is why it’s critical to integrate the most advanced technological tools. Access to support services is essential. Data shows that adults with mental illness experience a higher rate of unemployment at 7.4%, while students with depression are more than twice as likely to drop out of school. Further, 21% of unhoused individuals have been diagnosed with a serious mental illness. Leveraging the Lightbeam platform’s geo-targeting functionality can help care managers connect patients with a full portfolio of social services resources in their immediate areas.
Strengthened by technology and data intelligence, care teams are shifting focus to treating the entire person—meeting patients where they are and moving away from the practice of treating symptoms after they emerge. The new IBH Model emphasizes the importance of prevention, proactive approaches to mental wellness, and early identification of risks.
With integrated data-driven solutions, such as Lightbeam AI, Deviceless Remote Patient Monitoring, and clinical services, providers are transforming mental healthcare management and patient outcomes in rising-risk populations. To learn how Lightbeam can help you navigate the challenges, watch our webinar detailing how our client Sanford Health successfully scaled implementation for 1.5 million patients across 225,000 square miles in rural South Dakota through text-based interventions.
Briana Rodriquez, BSN, RN, Director, Clinical Programs, Care Management