title: The Early Impact Of The 'Alternative Quality Contract' On Mental Health Service Use And Spending In Massachusetts.
abstract: Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in participating organizations were slightly less likely to use mental health services and, among mental health services users, small declines were detected in total health care spending, but no change was found in mental health spending. The declines in probability of use of mental health services and in total health spending among mental health service users attributable to the AQC were concentrated among enrollees in organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program's initial years, but organizations are now at varying stages of efforts to improve mental health integration.
authors.affiliation: Colleen L. Barry (cbarry@jhu.edu) is an associate professor and associate chair for research and practice in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.affiliation: Elizabeth A. Stuart is a professor in the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: Julie M. Donohue is an associate professor in the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, in Pennsylvania.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.affiliation: Shelly F. Greenfield is a professor of psychiatry at McLean Hospital, in Belmont, Massachusetts.
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
authors.affiliation: Elena Kouri is project director in health care policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Elena
authors.initials: E
authors.lastname: Kouri
authors.affiliation: Kenneth Duckworth is medical director for behavioral health at Blue Cross Blue Shield of Massachusetts, in Quincy.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Duckworth
authors.affiliation: Zirui Song is a physician in the Department of Medicine at Massachusetts General Hospital, in Boston.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Robert E. Mechanic is a senior fellow at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mechanic
authors.affiliation: Michael E. Chernew is a professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
authors.affiliation: Haiden A. Huskamp is a professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
mesh_terms: D000293:Adolescent; D000328:Adult; D054598:Blue Cross Blue Shield Insurance Plans; D032982:Contracts; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011787:Quality of Health Care; D055815:Young Adult
keywords: Financing Health Care; Mental Health/Substance Abuse; Organization and Delivery of Care