Headline

Assigning dually eligible individuals with mental illness to accountable care organizations (ACOs) was associated with shifts to lower-cost outpatient settings, but did not affect overall spending and utilization.

Context

Individuals who are dually eligible for Medicare and Medicaid who also have behavioral health diagnoses incur high health care costs and may experience fragmented care due to their separate coverage under Medicare and Medicaid. ACOs can create incentives to coordinate care for populations with complex needs. Thus, ACOs may be more likely to implement interventions such as enhanced care management and integrated primary care that may improve outcomes and reduce costs for this population. This study examines whether attribution to an ACO for dually eligible individuals with mental illness was associated with changes in spending, utilization, and quality of care.

Findings

While ACO contract participation for dually eligible individuals with mental illness diagnoses did not affect spending or utilization, it was associated with higher rates of follow-up visits after mental health hospitalization. Some sub-groups with certain diagnoses experienced additional benefits – those ACO-attributed beneficiaries with schizophrenia, bipolar, or other psychotic disorders had more ambulatory visits, and those with depression had fewer emergency department visits.

Takeaways

While ACO participation improved some outcomes for dually eligible beneficiaries with mental illness, such as shifts to lower-cost outpatient care settings, it did not lead to overall changes in utilization and spending. ACOs will need to further tailor their approaches to improve mental health outcomes for dually eligible individuals, and models of integrated care for dually eligible individuals may help to inform future approaches.