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Medicare Payment Model Not Driving Improved Mental Health Outcomes
A recent study has found no differences in mental health between Medicare beneficiaries who received services through traditional fee-for-service programs and those enrolled in accountable care organizations.
Findings from the study, conducted by researchers at Washington University School of Medicine in St. Louis, Missouri, and the Yale School of Public Health, were published in the journal Health Affairs.
The study included a nationally representative sample of Medicare beneficiaries from 2016 to 2019.
“Accountable care organizations are the most important payment and care model in Medicare right now, and they do not appear to have improved mental health treatment for the 2 most prevalent mental health conditions in our society, which are depression and anxiety disorders,” senior author Kenton Johnston, PhD, an associate professor of medicine at Washington University, said in a news release. “In this study, only about half the people with depression or anxiety got any outpatient mental healthcare at all—and those in accountable care organizations got even less.
“People are supposed to get treatment for depression, anxiety, any kind of mental health condition in the same way they get treatment for diabetes or kidney disease but, in reality, that doesn’t really happen. There are changes that can be made to help get people the care they need.”
Accountable care organizations (ACOs), which were authorized as part of the Affordable Care Act, are networks of doctors and hospitals that commit to meeting all healthcare needs of a patient group. ACOs receive a payment for each patient based on the complexity of the patient’s medical needs, regardless of the actual cost of care. While ACOs are designed to deliver coordinated, high-quality care by integrating all services into a single health system, the study’s findings suggest ACOs, as currently structured, are not achieving their goals with regards to mental healthcare.
To conduct their study, researchers used de-identified data from the Medicare Current Beneficiary Survey to find Medicare recipients with diagnosed and undiagnosed depression and anxiety and who switched to an ACO between 2016 and 2019. Based on a review of 2500 patient-years of data, the researchers found that among patients not initially enrolled in an ACO, those who switched to one were no more likely to get mental health treatment and saw no improvements in their symptoms after 1 year compared to those in regular Medicare.
Dr Johnston pointed to ACOs’ incentive structure for doctors and hospitals as a possible reason for the results produced. Anxiety and some forms of depression, for example, are not currently in Medicare risk adjustment models, he noted.
“Medicare risk adjustment models, which ultimately determine payment to accountable care organizations, tend to under predict costs for people with depression and anxiety, so there’s not as much incentive and resources for treating those conditions,” Dr Johnston said. “We need to have more incentives and accompanying financial resources directed toward caring for people with mental health conditions.”
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