Medicare Accountable Care Organization Treatment of Serious Mental Illness: Associations Between Behavioral Health Integration Activities and Outcomes.
Helen Newton, Carrie H Colla, Susan H Busch, Marisa Tomaino, Brianna Hardy, Mary F Brunette, Devang Agravat, Ellen Meara
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引用次数: 0
Abstract
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.
目的：探讨重度精神疾病（SMI）成人医疗保险责任医疗机构（ACOs）行为健康整合能力与质量和利用的关系。背景：对照研究支持对重度精神障碍成人进行身心健康整合护理的有效性，但对整合护理的组织以及整合能力与质量之间的关系知之甚少。方法：我们调查了医疗保险ACOs(2017-2018年全国ACOs调查，回复率69%)，并将其与2016-2017年SMI受益人的按服务收费医疗保险索赔联系起来。我们检查了aco报告的整合能力（14项指数的位数）与7个患者水平的质量和利用结果之间的横断面关联。我们拟合了每个结果的广义线性模型，作为蚁群集成能力的函数，调整了蚁群和受益人的特征。结果：研究样本包括274,928个受益人年（199,910个独特受益人），归属于265个医疗保险aco。行为健康整合能力高的ACOs（顶层）比底层（63.7%）和中层（63.3%）服务更多的双重资格受益人（67.8%）。大多数受益人在精神健康住院和慢性病监测后30天接受随访（超过国家质量基准），但接受高五分位数（相对于低四分位数）ACOs护理的受益人接受随访的可能性略低[-2.17个百分点（pp）， P < 0.05]，糖尿病监测（-2.19 pp, P < 0.05）和心血管疾病监测（-6.07 pp, P < 0.05）。集成能力与利用率不相关。结论：为有大量身心健康需求的成人服务的ACOs更有可能报告综合整合能力，但尚未满足许多重度精神障碍成人的初级保健需求。
期刊介绍：
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.
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