RESEARCH WEEKLY: Accountable Care Organizations and Referrals for Individuals with Serious Mental Illness
By Nina Robertson
Patients with serious mental illness often lack access to specialty mental health support services such as assertive community treatment, supported employment and family psychoeducation, despite ample evidence that exhibits these services’ capacities to reduce hospitalizations and improve health outcomes. Accountable Care Organizations (ACOs) are groups of doctors, hospitals and care providers that give high-quality care to their Medicare patients with hopes of providing timely and efficient care that avoids duplication of services. ACOs contract with behavioral health providers that provide mental health support services, adopt technology or policies to facilitate data sharing, and pursue informal referral arrangements with providers to ensure individuals receive adequate care.
ACOs are incentivized to facilitate access to services that benefit individuals with serious mental illness. ACOs are often acclaimed as a leading innovation for population health. However, a recent study published in HealthCare found that fewer than 50% of ACOs reported that they are able to offer or refer patients to supported employment, family psychoeducation, assertive community treatment and illness, management and recovery services.
Study details
The authors conducted a cross-sectional analysis of the 2017-2018 National Survey of ACOs. This study evaluated evidence-based structural outcome measures related to support services recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA) that are likely to benefit patients with serious mental illness. The survey asked about ACO organizational characteristics, data sharing capability, and the ability to refer to specific evidence-based mental support services. Authors analyzed 412 ACOs of which 52% were physician-led, 37% served states in the South, 63% served Medicaid expansion states, and 28% included either a community mental health center (CMHC) or a behavioral health provider group.
Results
Analysis indicated that fewer than half of ACOs reported that providers have the ability to either offer or refer patients to specialty mental health support services. Survey results showed that 57.1% of ACOs were able to refer patients to services with integrated dual disorder treatment, while illness, management and recovery services were only offered by 41% of ACOs. Only 37.7% of ACOs reported tracking or referring patients who had experienced a first episode of psychosis and just 27.6% reported a significant relationship with a CMHC.
Implications
Fewer than half of ACOs reported that providers have the ability to offer or refer patients to specialty mental health support services. Authors state this may be due to a “lack of nearby behavioral health providers that offer these services and ACOs are unlikely or unable to induce centers to offer these programs.” Authors also state the lack of relationships between ACOs and CMHCs could be attributed to the strong incentives faced by capitated providers, those that are reimbursed based on a flat fee for each patient their service covers, or commercial insurers that create provider network limits on specialties like behavioral health.
Very few providers under ACOs are able to refer patients to vital services such as supported employment, family psychoeducation, assertive community treatment and illness, management and recovery services. The findings suggest that despite the innovation of payment and delivery services amongst ACOs, access to services is limited in the United States. The authors state that it is necessary to create complementary payment models that encourage formal relationships with specialty mental health organizations and incentives or resources that encourage adoption of support services. It is vital to enhance strategic planning and evaluation to ensure ACOs and delivery services are held responsible for providing referrals and consistent support to those with serious mental illness.
References
