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Accountable Care Organizations' Performance in Depression: Lessons for Value-Based Payment and Behavioral Health.

Nathaniel Z Counts1, Glenda Wrenn2, David Muhlestein3

  • 1Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA, 22314, USA. ncounts@mentalhealthamerica.net.

Journal of General Internal Medicine
|May 17, 2019
PubMed
Summary
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Value-based payment initiatives show low depression remission rates in Accountable Care Organizations (ACOs). Current ACO design may not incentivize mental health improvements, suggesting a need for incentive reforms.

Area of Science:

  • Health Services Research
  • Behavioral Health Outcomes
  • Value-Based Care

Background:

  • Value-based payment models, like the Medicare Shared Savings Program (MSSP), aim to improve health outcomes through financial incentives.
  • Accountable Care Organizations (ACOs) are increasingly reporting on behavioral health metrics, such as depression remission.

Purpose of the Study:

  • To evaluate the impact of value-based payment incentives on mental health and substance use outcomes within ACOs.
  • To assess whether current ACO designs effectively incentivize improvements in depression remission rates.

Main Methods:

  • Analysis of publicly reported depression remission rates for ACOs participating in the MSSP in 2017.
  • Comparison of ACO depression remission rates with rates of spontaneous remission from a meta-analysis.
Keywords:
behavioral healthdepressionmental healthpayment reformvalue-based payment

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Main Results:

  • The median depression remission rate at 12 months for reporting ACOs was 8.33% in 2017.
  • This rate is significantly lower than the approximately 53% spontaneous depression remission rate observed in a meta-analysis.
  • Current ACO design appears insufficient to incentivize improved behavioral health outcomes.

Conclusions:

  • Value-based payment initiatives, as currently designed within ACOs, may not be effectively driving improvements in mental health outcomes.
  • Reforms to value-based payment incentive design are needed, including easier data collection, increased incentive salience, capacity building, and safeguards.