A study published today in Health Affairs examined a nationally representative sample of Medicare beneficiaries from 2016 to 2019 and found no differences in mental health among Medicare beneficiaries who received their health care through through traditional fee-for-service programs and those enrolled in accountable care organizations.
The study was conducted by researchers at Washington University School of Medicine in St. Louis and Yale School of Public Health. Researchers noted that the idea behind ACOs is that by integrating all health services into a single system, patients will receive coordinated, high-quality care that results in better health, thereby reducing the costs of care health. The study results indicate that the program, as currently structured, is not achieving the goal of improving mental health care.
“Accountable care organizations are currently Medicare’s largest payment and care model and do not appear to have improved mental health treatment for the two most prevalent mental health problems in our society: depression and anxiety disorders,” said the lead author. Kenton Johnston, Ph.D., associate professor of medicine at the University of Washington, in a statement. “In this study, only about half of people with depression or anxiety received outpatient mental health care – and those working in accountable care organizations received even less. People are supposed to receive treatment for depression, anxiety, and any other mental health issues the same way they receive treatment for diabetes or kidney disease, but in reality, that doesn’t really happen. Changes can be made to help people get the care they need.
Overall, in 2022, the Medicare Shared Savings Program saved Medicare $1.8 billion without compromising quality of care, according to a report from the Centers for Medicare and Medicaid Services.
But the report’s authors say less is known about whether these organizations actually improve people’s health. To determine the effect of ACOs on mental health, Johnston and lead author Jason M. Hockenberry, Ph.D., chair of the Department of Health Policy and Management at the Yale School of Public Health, used anonymized Medicare data. Current Beneficiary Survey to find Medicare beneficiaries with diagnosed and undiagnosed depression and anxiety who transitioned to an accountable care organization between 2016 and 2019. In total, researchers collected and analyzed 2,500 patient years of data.
The results were clear: among patients who were not initially enrolled in an accountable care organization, those who did were no more likely to benefit from mental health treatment and saw no improvement in their symptoms after one year compared to those with regular Medicare.
“Overall, accountable care organizations had no effect on the quality of mental health care: all outcome measures were zero, except for one treatment measure for depression, which was actually worse,” Johnston said.
Researchers say the problem is at least partly due to the incentive structure given to doctors and hospitals. Figuring out how to measure quality of care and calculate equitable payment is complicated, and Medicare may not have found the right formula for mental health.
“Medicare’s risk adjustment models, which ultimately determine payment to accountable care organizations, tend to underestimate costs for people with depression and anxiety, so it does not “There aren’t as many incentives and resources to treat these conditions,” Johnston added. “Currently, anxiety is not even included in the model, which often means that accountable care organizations are underpaid to treat patients with these conditions. Some forms of depression are included in the model, but others are not. We need more incentives and supporting financial resources aimed at caring for people with mental health problems.
Johnston says he sees hope for improvement in the changing political climate. The pandemic has both highlighted and exacerbated mental health issues and, as a result, policymakers have become increasingly interested in addressing these issues.
“The Department of Health and Human Services recently released new guidelines aimed at providing people with the mental health care they need,” Johnston said. “I hope this study will lead policymakers to look at mental health quality measures in a more specific way.” »
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