A nationwide Medicare program that aims to improve health care and reduce costs by linking health-care reimbursements to health quality and cost outcomes resulted in no improvements in mental health care, according to a study by researchers at Washington University School of Medicine in St. Louis and the Yale School of Public Health. The study, which looked at a nationally representative sample of Medicare beneficiaries from 2016 to 2019, found no differences in mental health between Medicare beneficiaries who received their health care through traditional fee-for-service programs and those enrolled in accountable care organizations.
Authorized as part of the Affordable Care Act, accountable care organizations are networks of doctors and hospitals that commit to meeting all the health-care needs of a group of patients. The idea is that by integrating all health services into one system, patients will receive coordinated, high-quality care that will result in better health, thereby lowering health-care costs. The study’s findings, published Nov. 6 in Health Affairs, indicate that the program as currently structured is not meeting the goal of improving mental health care.
“Accountable care organizations are the most important payment and care model in Medicare right now and they do not appear to have improved mental health treatment for the two most prevalent mental health conditions in our society, which are depression and anxiety disorders,” said senior author Kenton Johnston, PhD, MPH, an associate professor of medicine at Washington University. “In this study, only about half the people with depression or anxiety got any outpatient mental health care at all — and those in accountable care organizations got even less. People are supposed to get treatment for depression, anxiety, any kind of mental health condition in the same way they get treatment for diabetes or kidney disease but, in reality, that doesn’t really happen. There are changes that can be made to help get people the care they need.”