ACO enrollment falls short in improving mental health access, with a 24% decline in treatment for depression and anxiety. Patient-reported outcomes remain unchanged. These findings prompt a reevaluation of ACOs in addressing common mental health conditions and suggest the need for potential modifications to enhance mental health screening and treatment within ACOs.
Accountable Care Organizations (ACOs) have gained prominence in the United States as a promising approach to enhancing healthcare quality and efficiency. ACOs aim to align payment incentives among various healthcare providers, focusing on the holistic well-being of patients. While the model has shown promise in chronic disease management, a recent study published in Health Affairs reveals that ACO enrollment may not have the desired impact on mental healthcare access and patient-reported outcomes (PROs).
The Study’s Findings:
The study, which analyzed data from the 2016 to 2019 Medicare Current Beneficiary Survey, focused on approximately 8,000 Medicare beneficiaries diagnosed with anxiety or depression. These individuals were eligible for ACO enrollment during the study period. The research team compared patients newly enrolled in a Medicare ACO with those who were never enrolled in an ACO.
Mental Healthcare Access:
Surprisingly, ACO enrollment did not lead to the expected improvements in mental healthcare access. It was associated with a 24% decrease in mental healthcare treatment during the year. Newly enrolled Medicare beneficiaries were 24% less likely to have an evaluation and management visit with any clinician for depression or anxiety. Additionally, they were 22% less likely to have an evaluation and management visit with a primary care provider. This decline was primarily due to lower rates of primary care visits addressing depression or anxiety among patients with depression.
Patient-Reported Outcomes (PROs):
One of the key findings of the study was that ACO enrollment had no significant impact on patient-reported outcomes and symptoms related to anxiety and depression. While ACOs were anticipated to play a crucial role in improving these outcomes, no substantial differences were observed. Consequently, despite the decrease in mental healthcare access, ACO enrollment did not negatively affect the well-being of patients with anxiety and depression.
Implications and Future Considerations:
The study’s results have far-reaching implications for the healthcare industry and its ongoing efforts to enhance mental healthcare access and quality. The findings raise questions about the effectiveness of ACOs in addressing common mental health conditions, which are often underdiagnosed among the Medicare population. Anxiety and depression often co-occur with other chronic conditions that ACOs typically target, making the need for effective mental healthcare even more critical.
In light of these findings, it becomes crucial to reevaluate the role of ACOs in managing mental health conditions. There may be opportunities to modify ACO screening requirements to increase the number of Medicare ACO enrollees receiving mental health treatment for their anxiety or depression. Recent changes to Medicare quality reporting guidelines have introduced requirements for depression screening and follow-up for individuals with depressive symptoms. While these targeted measures may enhance screening rates, further research is needed to assess whether follow-up leads to increased evidence-based mental health treatments, such as patient referrals to psychiatry and psychotherapy visits.
While ACOs have been championed as a solution for improving healthcare quality and efficiency, this study highlights that ACO enrollment does not significantly enhance mental healthcare access or PROs for patients with anxiety and depression. These findings underscore the need for ongoing evaluation and potential adjustments to the ACO model to ensure that it effectively addresses the mental health needs of patients, especially those with co-occurring chronic conditions. The healthcare industry must continue to explore innovative approaches to provide comprehensive and effective mental healthcare to all patients, regardless of their enrollment in ACOs.