Helen Newton1, Susan H Busch1, Mary F Brunette1, Donovan T Maust1, A James O'Malley1, Ellen Meara1. 1. Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara).
Abstract
Objective: This study examined whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness. Methods: This study used responses to the 2017–2018 National Survey of ACOs (55% response rate) to measure ACO-reported use of three integrated care strategies: care manager to address physical health treatment coordination or nonmedical needs (e.g., job support and housing), patient registries to track physical health conditions, and primary care clinician colocated in a specialty mental health setting. Logistic regression was used to determine associations between ACO characteristics and strategy use. Results: Of 399 respondents who answered questions on integration, 303 (76%) reported using at least one integrated care strategy in at least one location. Use of care managers (defined by the respondent) was most common (N=281, 70%), followed by use of a patient registry (N=146, 37%) and colocation of a primary care clinician in a specialty mental health setting (N=118, 30%). Respondents reporting that their largest Medicaid contract or largest commercial contract included quality measures specific to serious mental illness (e.g., antipsychotic adherence) were more likely to use each integrated care delivery strategy. Self-reported use of three collaborative care strategies (care management, patient registry, or mental health consulting clinician) for treatment of depression or anxiety was associated with use of integrated primary care and treatment for serious mental illness. Conclusions: In a national survey of ACOs, few respondents reported using either patient registries or primary care colocation to integrate primary care and treatment for serious mental illness.
Objective: This study examined whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness. Methods: This study used responses to the 2017–2018 National Survey of ACOs (55% response rate) to measure ACO-reported use of three integrated care strategies: care manager to address physical health treatment coordination or nonmedical needs (e.g., job support and housing), patient registries to track physical health conditions, and primary care clinician colocated in a specialty mental health setting. Logistic regression was used to determine associations between ACO characteristics and strategy use. Results: Of 399 respondents who answered questions on integration, 303 (76%) reported using at least one integrated care strategy in at least one location. Use of care managers (defined by the respondent) was most common (N=281, 70%), followed by use of a patient registry (N=146, 37%) and colocation of a primary care clinician in a specialty mental health setting (N=118, 30%). Respondents reporting that their largest Medicaid contract or largest commercial contract included quality measures specific to serious mental illness (e.g., antipsychotic adherence) were more likely to use each integrated care delivery strategy. Self-reported use of three collaborative care strategies (care management, patient registry, or mental health consulting clinician) for treatment of depression or anxiety was associated with use of integrated primary care and treatment for serious mental illness. Conclusions: In a national survey of ACOs, few respondents reported using either patient registries or primary care colocation to integrate primary care and treatment for serious mental illness.
Entities:
Keywords:
Accountable care organizations; Health care reform; Primary care; Quality improvement; Quality of care; Service delivery systems
Authors: Benjamin G Druss; Silke A von Esenwein; Michael T Compton; Kimberly J Rask; Liping Zhao; Ruth M Parker Journal: Am J Psychiatry Date: 2009-12-15 Impact factor: 18.112