Accountable Care Organizations (ACOs) were designed as a transformative strategy to improve healthcare delivery for Medicare patients. These organizations aim to reduce costs and improve care quality by aligning the incentives of healthcare providers, including clinicians, hospitals, and behavioral health professionals. By encouraging proactive care, ACOs have the potential to address chronic health conditions before they worsen, resulting in better outcomes for patients and more cost-effective care for payers. However, while ACOs have been effective in improving various aspects of healthcare, a new study published in Health Affairs raises significant concerns about their effectiveness in improving mental health care in ACOs outcomes, particularly for those suffering from anxiety and depression.
The study found that, despite ACOs’ design to provide comprehensive care, patients enrolled in these organizations did not experience measurable improvements in their mental health care in ACOs, specifically with regard to anxiety and depression. This lack of progress in treating such common and debilitating conditions is particularly concerning given the ongoing efforts to improve mental health care in ACOs treatment access and quality for Medicare beneficiaries. In fact, the study highlighted that new ACO enrollees were 24% less likely to receive treatment for anxiety or depression during their first year of enrollment, primarily due to lower rates of primary care visits addressing these issues. Even more troubling, the study found no improvement in self-reported depression or anxiety symptoms a full year after ACO enrollment.
The ACO Model and Its Goals for Mental Health
ACOs were introduced with the promise of reducing healthcare costs by providing better, more coordinated care that focuses on prevention and early intervention. The model encourages collaboration among providers, including primary care physicians, specialists, and behavioral health professionals, to ensure that patients receive comprehensive care for both chronic physical and mental health conditions. Mental health care in ACOs was envisioned as an integral part of this coordinated model, but the study indicates that mental health treatment has not been prioritized as intended.
The premise behind ACOs is that by incentivizing proactive care for chronic conditions, the system can reduce the need for expensive emergency room visits and hospitalizations by addressing issues before they become more severe. Mental health conditions are a natural fit for this model, as they often lead to worse physical health outcomes and higher medical costs when left untreated. The goal was that ACOs could reduce the burden of mental health care in ACOs through better coordination and proactive treatment, but the study shows this has not been realized for patients with anxiety and depression.
However, despite these intentions, the new study found that ACO enrollment did not lead to improved mental health care in ACOs for patients. Specifically, anxiety and depression symptoms did not show any measurable improvement after one year in the program. The study showed that new ACO enrollees were significantly less likely to receive treatment for depression or anxiety during their initial year, compared to their pre-enrollment care. This result is especially concerning given that mental health conditions like anxiety and depression are prevalent in Medicare populations and are known to worsen if left untreated. Even though ACOs were designed to provide a more holistic, proactive approach to healthcare, the study showed that mental health was not being adequately addressed.
Data and Findings from the Study
The researchers analyzed claims and enrollment data from the Medicare Current Beneficiary Survey (MCBS) from 2016 to 2019. The data sample included patients who were not initially enrolled in ACOs, allowing the study to compare rates of mental health treatment and outcomes before and after enrollment. The study found that, despite the intentions of ACOs to improve care quality, patients in the program did not experience any significant improvements in their mental health.
The study also found that patients enrolled in ACOs were 24% less likely to receive treatment for depression or anxiety during their first year, compared to their pre-enrollment care. This result is especially concerning given that mental health conditions like anxiety and depression are prevalent in Medicare populations and are known to worsen if left untreated. Even though ACOs were designed to provide a more holistic, proactive approach to healthcare, the study showed that mental health was not being adequately addressed.
Recommendations for Improvement
Given the findings of the study, the authors recommended several changes to improve mental health care in ACOs. First, they suggested that incentives should be better aligned with mental health parity and equity. ACOs should be encouraged to prioritize mental health treatment by implementing specific measures that focus on improving access to care for individuals with mental health conditions, particularly those from vulnerable populations.
Another important recommendation was to increase the number of mental health providers who are willing to accept Medicare and contract with ACOs. One way to do this could be to raise Part B payment rates for mental health professionals, which would help address the current shortage of providers willing to participate in ACOs. Additionally, ACOs should be required to establish stronger provider networks to ensure that patients can access mental health services when needed.
The Future of ACOs and Mental Health Care
As the Centers for Medicare & Medicaid Services (CMS) moves forward with plans to enroll all Medicare beneficiaries in ACOs by 2030, the need for improved mental health care within these organizations becomes even more pressing. The current study underscores the importance of revisiting the design of ACOs to ensure that they adequately address the mental health needs of their enrollees.
Without meaningful changes, ACOs may continue to fall short in providing comprehensive mental health care in ACOs, especially for patients with anxiety and depression. As mental health issues continue to rise, particularly in aging populations, it will be crucial for ACOs to evolve and prioritize mental health treatment alongside physical health. Only by doing so can ACOs truly fulfill their mission of improving care, reducing costs, and enhancing the overall health and well-being of Medicare beneficiaries.
