Depression and Metabolic Health Intensive Outpatient Program (IOP)

A VBOHC | Oak Mountain Outdoor Healthcare Program

Program Overview

Duration: 12 weeks
Intensity: 3 days per week, ~3 hours/day

Services include:

  • Individual psychotherapy

  • Outdoor group psychotherapy

  • Metabolic screening, lab monitoring, and medication management

  • Nutritional and movement-based interventions

  • Trauma-informed, systems-based care (family and relational context)

  • Care coordination and social needs navigation

Unlike conventional IOPs, this model embeds green and blue space exposure as structured, measurable clinical interventions rather than optional or recreational activities.

Green Space Exposure Includes:

  • Forested trails

  • Meadows, parks, and natural open spaces

  • Outdoor treatment sessions and movement-based groups

Blue Space Exposure Includes (where available):

  • Lakeshores, rivers, streams, and reflective water environments

  • Mindfulness and regulation activities conducted near water

The model explicitly measures dose, quality, and equity of environmental exposure as part of clinical care.

Exposure Metrics Include:

  • Average weekly minutes of structured green space exposure

  • Average weekly minutes of structured blue space exposure

  • Type of exposure (walking, therapy session, mindfulness, group activity)

  • Seasonal variation

  • Patient-reported perceived safety and accessibility

Outcome Linkages:

  • Correlation of exposure dose with:

    • PHQ-9 improvement

    • HbA1c reduction

    • Blood pressure changes

    • Sleep quality

    • Inflammatory surrogates (where available)

Equity Lens:

  • Comparison of participant baseline environment access vs IOP-provided exposure

  • Outcomes stratified by neighborhood deprivation index and rurality

To support CMS learning goals and long-term policy relevance, OMOHC will establish a limited, consent-based clinical biobank embedded within routine care.

The biobank is designed to:

  • Support implementation science, not exploratory genetics

  • Examine biological correlates of environment-first interventions

  • Inform future standardized quality measures

Collected at baseline, discharge, and selected follow-ups:

  • Blood samples (HbA1c, lipids, inflammatory markers)

  • Salivary cortisol (stress response)

  • Optional epigenetic markers related to stress and inflammation

All samples are:

  • De-identified

  • HIPAA compliant

  • IRB-approved

  • Never used for predictive underwriting or eligibility determinations

Biobank data will be linked to:

  • Clinical outcomes

  • Environmental exposure metrics

  • Utilization and cost data

This allows CMS to evaluate mechanism, not just correlation, while preserving patient protections.

Payment Approach:

  • Prospective bundled payment per IOP episode

  • Includes:

    • Behavioral health services

    • Medical and metabolic management

    • Outdoor and environment-based interventions

    • Care coordination and digital tools

Performance Incentives:

  • Depression remission/improvement

  • HbA1c and metabolic improvement

  • Reduced ED and inpatient utilization

  • Equitable outcomes across demographic groups

This model shifts payment away from volume-based fragmentation toward condition-informed recovery trajectories.

Methods:

  • Pre-post outcomes analysis

  • Matched comparison group using claims and clinical data

  • Qualitative interviews with participants and clinicians

Primary Outcomes:

  • Change in PHQ-9

  • Change in HbA1c

  • Change in blood pressure and BMI

Secondary Outcomes:

  • PMPM total cost of care

  • Hospital and ED utilization

  • Functional status and patient experience

  • Environmental exposure dose-response relationships

This demonstration aligns directly with CMS priorities for:

  • Mental health integration

  • Chronic condition prevention and management

  • Health equity

  • Value-based payment reform

  • Whole-person care

  • Evidence-generating models with national scalability

If successful, this model can be:

  • Replicated in urban, suburban, and rural settings

  • Deployed through existing health systems

  • Codified into future CMS benefit and payment guidance

This demonstration positions environment not as an add-on, but as a clinical determinant—measurable, accountable, and financeable within value-based care.

This IOP is structured for:

  • 1115 demonstration alignment

  • CMMI model-test readiness

  • Risk-stratified care pathways

  • Cardiovascular + behavioral health quality measures

  • Total cost of care reduction

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