A national Medicare program designed to enhance healthcare quality and reduce costs by tying healthcare reimbursements to health outcomes and cost-effectiveness has shown no improvements in mental health care. A study conducted by researchers at Washington University School of Medicine in St. Louis and the Yale School of Public Health analyzed a representative sample of Medicare beneficiaries between 2016 and 2019. The research found no significant differences in mental health outcomes between Medicare beneficiaries who received care through traditional fee-for-service programs and those enrolled in accountable care organizations.
Accountable Care Organizations and Their Purpose:
Accountable care organizations are networks of medical professionals and hospitals committed to providing comprehensive healthcare to a specific group of patients. The aim is to integrate all health services into a unified system, ensuring coordinated, high-quality care leading to improved health outcomes and reduced healthcare costs. The study’s findings, published in Health Affairs, raise concerns that the program, as currently structured, is not achieving its intended goal of enhancing mental health care.
Study’s Main Findings:
Accountable care organizations, considered the most crucial payment and care model in Medicare, have not shown improvements in the treatment of prevalent mental health conditions like depression and anxiety disorders.
Only about half of the individuals with depression or anxiety received outpatient mental health care, and those in accountable care organizations received even less.
The study found that the quality of mental health care remained unchanged, with some treatment measures for depression showing negative outcomes.
The incentive structure for healthcare providers, particularly doctors and hospitals, may be a contributing factor to this failure, as Medicare’s risk adjustment models tend to underpredict costs for people with depression and anxiety. This results in less incentive and fewer resources dedicated to treating these conditions.
Conclusion:
The study’s results highlight the need for adjustments in the incentive structure and resource allocation for mental health within accountable care organizations. The current model may not adequately address the complexities of mental health care. However, there is hope for improvement as the political landscape evolves. The COVID-19 pandemic has underscored and exacerbated mental health challenges, prompting policymakers to show a growing interest in addressing these issues. The Department of Health and Human Services has issued new guidelines to improve access to mental health care, which, coupled with studies like this one, may lead to more specific and effective measures to address mental health concerns.
