The Kennedy Forum led a cross-sector coalition to call on the Centers for Medicare & Medicaid Services (CMS) to rethink how the health care system accounts for the cost of behavioral health care.

In comments on CMS’s proposed 2027 Physician Fee Schedule, the coalition recommends adopting cost measures that recognize the value of prevention and chronic disease management. This builds on The Kennedy Forum’s prior advocacy and research regarding prevention-focused payment models, moving mental health care from volume to value.

The comments were signed by The Kennedy Forum, the American Foundation for Suicide Prevention, the American Psychiatric Association, the American Psychological Association Services, Shatterproof, and The ERISA Industry Committee.

The Case for Financing Prevention: Looking Beyond the Cost of Care

Current value-based payment models largely measure Total Cost of Care within a defined period. While these measures can reduce preventable events and low-value care, they do not fully capture the longer-term savings that can result when a health condition is prevented or addressed earlier.

The coalition recommends expanding cost measurement to include the Net Present Value of Care (NPVoC), which recognizes both savings achieved during a performance period and the expected future value of improved health outcomes.

The principle is well established in physical health for issues like diabetes or heart disease, with studies consistently reflecting better health outcomes, personal savings, and collective economic benefits. 

Behavioral intervention can alter the trajectory of behavioral health conditions, reducing the need for more intensive treatment while supporting people’s ability to participate in their workplaces, families, and communities. Half of all lifetime mental health disorders begin by age 14, and three-quarters begin by age 24.

“Mental health and addiction are issues we can screen for and target early, just like any other illness,” said Rebecca O. Bagley, President and CEO of The Kennedy Forum. “Insurers, clinicians, and advocates can all agree that we must consider the full value of prevention, not only for individuals but for the communities, workplaces, and lives they can contribute to more fully and with greater health.”

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