TY - JOUR
AU - H. Newton
AU - C. H. Colla
AU - S. H. Busch
AU - M. Tomaino
AU - B. Hardy
AU - M. F. Brunette
AU - D. Agravat
AU - E. Meara
A1 - 
AB - OBJECTIVE: Characterize the association between Medicare Accountable Care Organizations' (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI). BACKGROUND: Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality. METHODS: We surveyed Medicare ACOs (2017-2018 National Survey of ACOs, response rate 69%) and linked responses to 2016-2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics. RESULTS: Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring-exceeding national quality benchmarks-but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [-2.17 percentage points (pp), P < 0.05], diabetes monitoring (-2.19 pp, P < 0.05), and cardiovascular disease monitoring (-6.07 pp, P < 0.05). Integration capability was not correlated with utilization. CONCLUSIONS: ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI.
AD - Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC.; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH.; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.; Rutgers Institute for Nicotine and Tobacco Studies, Rutgers University, New Brunswick, NJ.; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA.; Departments of Psychiatry, Community and Family Medicine and The Dartmouth Institute, Geisel School of Medicine, Dartmouth, Hanover, NH.; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord NH.; Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Center, Seattle, WA.; National Bureau of Economic Research, Cambridge, MA.; National Bureau of Economic Research, Boston, MA.
AN - 39616411
BT - Med Care
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities
CP - 2
DA - Feb 1
DO - 10.1097/mlr.0000000000002102
DP - NLM
ET - 20241129
IS - 2
JF - Med Care
LA - eng
N2 - OBJECTIVE: Characterize the association between Medicare Accountable Care Organizations' (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI). BACKGROUND: Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality. METHODS: We surveyed Medicare ACOs (2017-2018 National Survey of ACOs, response rate 69%) and linked responses to 2016-2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics. RESULTS: Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring-exceeding national quality benchmarks-but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [-2.17 percentage points (pp), P < 0.05], diabetes monitoring (-2.19 pp, P < 0.05), and cardiovascular disease monitoring (-6.07 pp, P < 0.05). Integration capability was not correlated with utilization. CONCLUSIONS: ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI.
PY - 2025
SN - 0025-7079
SP - 123
EP - 132+
ST - Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes
T1 - Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes
T2 - Med Care
TI - Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities
U3 - 10.1097/mlr.0000000000002102
VL - 63
VO - 0025-7079
Y1 - 2025
ER -