A recent study found that accountable care organizations do not have a positive influence on treatment and outcomes for chronic mental health conditions for Medicare patients. Health Affairs recently published a study on Medicare patients who were diagnosed with anxiety and depression and who were enrolled in ACOs.
ACOs have become a popular care model for Medicare providers as policy makers believe that ACOs tend to improve the quality and efficiency of care for chronic conditions. The study notes that depression and anxiety disorders are the most common and undertreated chronic mental health conditions in Medicare. The authors of the study, therefore, undertook the research to use longitudinal data from the 2016-2019 Medicare Current Beneficiary Survey and linked it to validated depression and anxiety symptom instruments, among diagnosed and undiagnosed fee-for-service Medicare patients with those conditions.
The study found that “among patients not enrolled in ACOs at baseline, those who newly enrolled in ACOs in the following year were 24% less likely to have their depression or anxiety treated during the year than patients who remained unenrolled in ACOs, and they saw no relative improvements at twelve months in their depression and anxiety symptoms.” The study also found that patients newly enrolled in ACOs were 9.8% less likely to have an evaluation and management visit for depression or anxiety with a primary care provider.
“ACO enrollment was not associated with any other differences in ambulatory mental health treatment, including antidepressant prescribing or visits to mental health specialists,” the study states. “Perhaps most notably, ACO enrollment was not associated with any discernible improvements in patient-reported depression or anxiety symptoms at twelve months, which is especially concerning in light of the lower rates of ambulatory mental health treatment in this new ACO enrollee group as compared with the non-ACO group.”
The study also found that while recent Medicare requirements may result in higher rates of depression screenings and follow-ups, those screenings may not result in mental health treatment, such as patient referrals to psychiatry and psychotherapy visits. Quality scores given to ACOs through the Merit-based Incentive Payment System are also not shown to be tightly correlated with “actual quality of patient care delivered in that setting.”
Therefore, the study concludes, better-designed incentives are necessary to motivate Medicare ACOs to improve mental health treatment to achieve better outcomes. One suggestion was to update the CMS-HCC Risk Adjustment Model while another suggestion was to establish mental health provider network adequacy standards and increase Part B payment rates for providers to expand the network of mental health providers that contract with ACOs.