title: Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management.
abstract: People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it.
authors.affiliation: Alisa B. Busch (abusch@partners.org) is an assistant professor of psychiatry and health care policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Busch
authors.affiliation: Haiden A. Huskamp is a professor of health care policy at Harvard Medical School.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.affiliation: J. Michael McWilliams is an associate professor of health care policy and medicine at Harvard Medical School.
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D019468:Disease Management; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D020380:Needs Assessment; D014481:United States
keywords: Cost of Health Care; Medicare, Mental Health/Substance Abuse; Organization and Delivery of Care; Quality Of Care