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Are accountable care organizations (ACOs) potentially creating financial savings by neglecting or limiting care for serious mental illness (SMI)? A team of researchers has examined the issue for an article in Health Affairs. Based on their analysis, it appears that such is not the case; but there is complexity, which the researchers explore in their article.
In the article published in the August issue of Health Affairs and entitled “ACO Participation Associated With Decreased Spending For Medicare Beneficiaries With Serious Mental Illness,” José F. Figueroa, Jessica Phelan, Helen Newton, E. John Orav, and Ellen R. Meara look at the complexities around care for serious mental illness for Medicare patients enrolled in Medicare Shared Savings Program (MSSP) ACOs. What they find is complex and somewhat nuanced.
The authors state in their abstract at the outset of the article that “Serious mental illness (SMI) is a major source of suffering among Medicare beneficiaries. To date, limited evidence exists evaluating whether Medicare accountable care organizations (ACOs) are associated with decreased spending among people with SMI. Using national Medicare data from the period 2009–17, we performed difference-in-differences analyses evaluating changes in spending and use associated with enrollment in the Medicare Shared Savings Program (MSSP) among beneficiaries with SMI. After five years, participation in MSSP ACOs was associated with small savings for beneficiaries with SMI (−$233 per person per year) in total health care spending, primarily related to savings from chronic medical conditions (excluding mental health; −$227 per person per year) and not from savings related to mental health services (−$6 per person per year). Savings were driven by reductions in acute and post-acute care for medical conditions. Further work is needed to ensure that Medicare ACOs invest in strategies to reduce potentially unnecessary care related to mental health disorders and to improve health outcomes.”