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Treating Behavioral Health Disorders in an Accountable Care Organization
Neil D. Minkoff, MD

Treating Behavioral Health Disorders in an Accountable Care Organization

Neil D. Minkoff, MD
Integrating behavioral and physical health services within an accountable care organization offers a significant opportunity to address both behavioral health conditions and substance use disorders, as well as to improve outcomes and reduce costs.
• Developing structural approaches to enhance the capacity of organizations and providers to provide effective, quality care. This could include accreditation, certification, recognition, and payment programs, such as Medicaid Health Homes and the National Committee for Quality Assurance’s patient-centered medical home and specialty recognition programs, which incentivize outcome-focused care.

• Encouraging the integration of behavioral and physical health services, as described earlier in this article.

• Expanding quality measures related to the use of effective patient-centered psychosocial interventions, such as talk therapy.

• Adding quality measures around the management of SUDs.

Table 334 highlights state efforts in these areas.34

Alignment With Existing Initiatives

Integrating behavioral and physical health services should build on existing programs within ACOs. For instance, some ACOs already employ social workers and other behavioral health specialists for short-term support. New York state is working with existing “health home” programs, which provide care for complex patients, to grow them into ACOs and is providing grants to behavioral health providers to encourage them to better collaborate with health homes. Those health homes are already required to support care management across physical and behavioral health services and create links to community support and housing.34

ACOs should also investigate the numerous state and federal grants available for behavioral health integration. For instance, the SAMHSA-HRSA Center for Integrated Health Solutions has awarded more than $26.2 million in grants to 100 community-based behavioral health organizations to support integration of primary care services into these settings.34

A 2010 report from the Agency for Healthcare Research and Quality highlights several essential measures needed to facilitate an integrated mental health model in the primary care setting16:

• Normalize mental health into mainstream medical practice. This requires cultural shifts to move away from the stigma of behavioral health problems and recognize these conditions as chronic health conditions no different from diabetes and asthma. It also requires redesigning workflows and providing physicians with the technical and leadership skills they require for full integration.

• Integrate reimbursement mechanisms. This includes eliminating separate coding and billing procedures.

• Create a roadmap for implementation. This includes research that identifies the most effective and cost-effective primary care models for this population and the development of decision support tools that identify patients who require integrated services.

• Create and/or disseminate the tools providers need. This requires guidance and technical assistance for implementing integrated care, research, and valid screening, diagnostic, and monitoring instruments.

Conclusions

One in 3 individuals in this country has a behavioral health disorder, whether a mental illness, SUD, or both. These patients garner healthcare costs far higher than those without such disorders, experience greater morbidity and earlier mortality, and are more likely to experience comorbid physical health conditions. They also receive substandard care for their behavioral health disorders and experience difficulties accessing primary care for their physical health disorders. The traditional separation between behavioral and physical health services in the medical field contributes to these access and quality issues.

Integrating behavioral and physical health services within an ACO offers a significant opportunity to address both of these problems, as well as improves outcomes and reduces costs. However, ACOs, which have traditionally focused on physical health conditions, have been slow to incorporate behavioral health within their population health focus. Barriers include a lack of quality incentives, behavioral health providers, and a robust IT infrastructure.

The value-based reimbursement model under which ACOs operate, however, should incentivize these organizations to better address behavioral health conditions in order to improve the overall health of their population. However, payers need to ensure that financial incentives are aligned to encourage this by including behavioral health outcomes and responsibilities within any capitation and/or shared savings plans. They should also support the development of interoperative information systems and legislative changes that encourage the full integration of behavioral and physical health services.

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