Create an ACO screening demonstration
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should create a Medicare demonstration project with one or more accountable care organizations in which they screen for all common mental health and substance use disorders (MH/SUDs), including depression, anxiety disorders, psychoses, bipolar disorder, schizophrenia, and various addictions, and track outcomes for all of these conditions by using a quantifiable and standardized symptom rating scale.[1]
Background/summary
Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other healthcare providers who work together to coordinate the delivery of health care treatment and services on behalf of a patient. ACOs have been shown to be effective at reducing waste without compromising the quality of care, particularly for those with chronic conditions.[2][3] However, services for MH/SUDs have generally been left out of the ACO model despite the known cost and quality benefits of integrating MH/SUD care into primary care practices.[4][5] Screening for MH/SUD within ACOs continues to be primarily limited to depression and alcohol use disorder based on CMS’ preventive services guidelines.[6]
Medicare demonstration programs allow providers to test innovative approaches to care delivery while being sponsored by CMS, thus reducing risk to healthcare organizations. Given the known benefits of ACOs and the known benefits of MH/SUD care integration in other settings, a demonstration program that leverages ACOs to screen for all common MH/SUDs, including depression, anxiety disorders, psychoses, bipolar disorder, schizophrenia, and various addictions has significant opportunity for improving outcomes. The demonstrations should be evaluated on a standardized and quantifiable symptom rating scale to be monitored for efficacy.[1]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Updated October 2017.
2. Centers for Medicare and Medicaid Services. Accountable Care Organizations (ACOs): General Information. Last Updated April 13, 2023.
3. Health Affairs. The Case For ACOs: Why Payment Reform Remains Necessary. Last Updated January 24, 2022.
4. O’Donnell, Allison N., Brent C. Williams, Daniel Eisenberg, Amy M. Kilbourne. “Mental Health in ACOs: Missed Opportunities and Low Hanging Fruit.” National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information. Last Updated April 4, 2013.
5. Schrager, Sarina. “Integrating Behavioral Health Into Primary Care.” FPM Journal. Last Updated June 2022.
6. U.S. Department of Health and Human Services. Preventive care benefits for adults. Last Accessed July 26, 2023.