Study finds that ACOs do not lead to enhancements in mental health results

A recently published study in Health Affairs has revealed that accountable care organizations (ACOs) do not yield positive effects on the treatment and outcomes of chronic mental health conditions in Medicare patients. The study suggests that individuals who recently joined ACOs did not show any apparent enhancements in symptoms of depression and anxiety throughout a one-year period.

These patients were 24% less likely to receive treatment for depression or anxiety compared to their counterparts not enrolled in ACOs. Moreover, they demonstrated a 9.8% decrease in the likelihood of undergoing an evaluation and management visit for depression or anxiety with a primary care clinician.

Given the frequent underdiagnosis and undertreatment of mental health conditions in Medicare patients, there was a prevailing belief that ACOs might be well-suited to address these challenges. However, the study found no notable disparities in various measures of mental health treatment.

 The report explicitly stated, “ACO enrollment was not associated with any other differences in ambulatory mental health treatment, including antidepressant prescribing or visits to mental health specialists.” Significantly, the enrollment in ACO did not result in noticeable enhancements in patient-reported depression or anxiety symptoms within the twelve-month period. This raises concerns, especially when taking into account the lower rates of ambulatory mental health treatment among new ACO enrollees in comparison to the non-ACO group.

Patients within ACOs who experienced depression or anxiety presented with a more favorable risk and functional health risk profile and were less likely to reside in rural areas compared to patients not enrolled in ACOs.

The study outlined that while recent Medicare requirements might result in increased rates of depression screenings and follow-ups, these screenings may not translate into desired mental health treatments, such as patient referrals to psychiatry and psychotherapy visits. 

Furthermore, the quality scores allocated to ACOs via the Merit-based Incentive Payment System did not exhibit a robust correlation with the tangible quality of patient care provided in that environment. Some physicians expressed skepticism, casting doubt on whether value-based payment measures significantly enhance care enough to warrant the associated administrative burden.

The study issued a cautionary note, suggesting that if patients and their providers, especially those from marginalized communities, perceive that their values and needs are not prioritized within the program, there may be continued migration from traditional Medicare to the Medicare Advantage program.

In response to these findings, the study called for policymakers to intensify monitoring of mental health treatment by ACOs and to reconsider incentives. It recommended updating the CMS-HCC risk adjustment and payment model. Furthermore, the study proposed the establishment of mental health provider network adequacy standards and advocated for an increase in Part B payment rates for providers. This adjustment could potentially attract a broader pool of mental health providers willing to contract with ACOs.

The research team that consisted of scholars from Yale, Harvard, Emory, Saint Louis University, and Washington University in St. Louis, leveraged data from the 2016-2019 Medicare Current Beneficiary Survey linked to depression and anxiety symptom instruments for diagnosed and undiagnosed fee-for-service Medicare patients. Currently, approximately 13 million beneficiaries are enrolled in Medicare ACOs. The model is gaining popularity as it seeks to assist providers in focusing on patients with severe or acute medical needs, steering away from neglecting those with complex needs and low reimbursement.