Increasing Integration of Behavioral Health Care in ACOs

Delivery of care in the United States is changing, and a recent study found that many accountable care organizations (ACOs) are recognizing this transition—and they’re moving forward. With the goal of an ACO being to reduce costs while improving health outcomes as well as quality of life, many ACOs are beginning to understand the impact of behavioral health conditions on both quality and cost, and are integrating behavioral health care into their practices.

A study published in Health Affairs noted that previous research has indicated that individuals with chronic conditions, such as diabetes, cardiovascular and pulmonary disease, and who are high users of healthcare services are more likely to have behavioral health conditions. Research found that individuals, for example, with diabetes or heart failure and comorbid depression had 4.5 times higher total costs of care than individuals without mental health comorbidities. Those with mental health conditions and chronic comorbid diseases were also associated with poorer adherence to treatment and quality of care than those without. However, a 2013 study had found that most ACOs hadn’t moved from a traditional and fragmented fee-for-service reimbursement model.

As a result, this new research study sought to examine where and how behavioral health could be improved in the ACO model, specifically in the Medicare ACOs. Researchers examined various ACOs under the Medicare Shared Savings Program and the Advance Payment ACO Model.

The research team conducted various interviews and site visits throughout the length of the study and found that almost all ACO personnel recognized the impact of behavioral health on utilization and spending. Additionally, researchers found that many of the ACO care coordination teams understood that a greater percentage of their patients who were high risk and high cost had complex behavioral health and psychosocial needs. Among the various types of ACOs, the study discovered that Shared Savings ACOs were more likely to have developed at least 1 approach to addressing behavioral health than Advance Payment ACOs.

While the study reported that many of the ACOs were beginning to adopt various programs or strategies into their framework to increase patient access to behavioral health care, either through means of social workers, referral networks or screenings, ACOs still face several challenges in making this transition. Many ACO officials cited a lack of behavioral health professionals as a barrier to successful implementation, while others cited reimbursement issues with Medicare, where either the reimbursement was too low or that the behavioral health care provider faced issues in billing to Medicare.

“Significant challenges remain, such as those related to provider access, sustainable financing models, data sharing, and resistance to treatment by both providers and patients,” the authors wrote in the report. “However, the ongoing shift toward capitated payments is driving a new era of coordination and integration between physical and behavioral health that will expand the models for effective and improved health care to address all health needs.”