ACO Enrollment Doesn’t Help Mental Healthcare Access, PROs

November 07, 2023 - Being enrolled in an accountable care organization (ACO) won’t do much to improve a patient’s mental healthcare access or symptom burden; in fact, ACO enrollment has proven to hamper access to care and decrease patient-reported outcomes for folks with depression and anxiety disorders, a new Health Affairs study says.

The data, obtained via email, shows that Medicare beneficiaries newly enrolled in Medicare ACOs see a 24 percent drop in mental healthcare treatment during the year, plus no relative improvement in their anxiety and depression symptoms.

These findings come as the United States healthcare system looks to ACOs as the gold standard in chronic disease management.

“The movement toward the ACO model is driven by the hope that aligning payment incentives among physicians, hospitals, behavioral health providers, and other care providers to improve quality and efficiency of care might improve outcomes for patients, lower spending, or both,” the research team wrote in the study’s introduction.

“The design of such models should, in theory, lead ACO providers to focus on patients with conditions that might be overlooked because they are complex—which is common in patients with more severe, acute, and immediate medical needs—or are tied to low reimbursement.”

This has led many in the industry to consider ACOs a top-tier strategy for managing common mental health conditions, like anxiety and depression. Anxiety and depression are both underdiagnosed among the Medicare population and they can co-occur with other chronic conditions often targeted within ACOs.

Nonetheless, enrollment in an ACO made little difference in treatment for anxiety and depression, which the researchers measured by looking at the odds of receiving treatment and patient-reported outcomes (PROs).

The team looked at data from the 2016 to 2019 Medicare Current Beneficiary Survey for around 8,000 Medicare beneficiaries with diagnosed and undiagnosed anxiety or depression who were eligible for ACO enrollment during the study period. In particular, they compared patients who were newly enrolled in a Medicare ACO and those who were never enrolled in an ACO at all.

Overall, enrolling in an ACO did not have the added benefit some experts may have hoped, the researchers found.

Folks newly enrolled in an ACO were 24 percent less likely to have an evaluation and management visit with any clinician for depression or anxiety and 22 percent less likely to have an evaluation and management visit with a primary care provider.

“This was primarily due to lower rates of primary care visits addressing depression or anxiety among patients with depression,” the research team said.

Being enrolled in an ACO didn’t make patients feel any better, either, but it also didn’t make them feel any worse. Researchers observed no difference in patient-reported outcomes and symptoms related to anxiety and depression. They said this was particularly problematic due to the lower rates of ambulatory mental health treatment for new ACO enrollees versus non-enrollees.

There could be room for changing screening requirements within ACOs to increase the number of Medicare ACO enrollees who receive mental health treatment for their anxiety or depression.

“Recent changes to Medicare quality reporting guidelines include requirements for depression screening and follow-up for those whose scores indicate depression,” the researchers explained. “This type of targeted measure may improve screening rates, but it remains to be seen whether follow-up also improves downstream evidence-based mental health treatments, such as patient referrals to psychiatry and psychotherapy visits.”