Nationwide Medicare Program Fails to Improve Mental Health, New Study Shows

A new study suggests that a nationwide Medicare program designed to improve health care and reduce costs by providing financial incentives to doctors and hospitals has resulted in no improvements in mental health care.

The research, conducted jointly by researchers from Washington University School of Medicine in St. Louis and the Yale School of Public Health, analyzed a representative sample of Medicare beneficiaries from 2016 to 2019.

The study discovered no significant disparities in mental health outcomes between beneficiaries enrolled in the traditional fee-for-service programs and those participating in accountable care organizations.

Accountable Care Organizations

Accountable care organizations, established under the Affordable Care Act, are networks of healthcare providers committed to overseeing the comprehensive healthcare needs of a specific patient group.

The principle underlying this model is that by unifying healthcare services into a single system, patients can receive integrated, high-quality care, ultimately leading to better health outcomes and reduced healthcare expenses. However, the study claimed that the current program structure has not effectively advanced mental health care as intended.

Senior author Kenton Johnston, Ph.D., an associate professor of medicine at Washington University, said, "Accountable care organizations are the most important payment and care model in Medicare right now and they do not appear to have improved mental health treatment for the two most prevalent mental health conditions in our society, which are depression and anxiety disorders."

He further emphasized that approximately only half of individuals with depression or anxiety sought any form of outpatient mental health care, with those in accountable care organizations receiving even less.

The study noted that accountable care organizations receive compensation based on each patient's medical complexity, irrespective of the actual cost of their care.

They share in the savings with Medicare when costs are contained while meeting quality benchmarks, but they also shoulder financial responsibility when costs exceed projections. This financial incentive aims to control costs while upholding or enhancing care quality.

'No Effect'

This study, led by Jason M. Hockenberry, Ph.D., the chair of the Department of Health Policy and Management at the Yale School of Public Health, employed de-identified data from the Medicare Current Beneficiary Survey to assess the mental health outcomes of individuals who transitioned to an accountable care organization between 2016 and 2019.

The findings indicated that individuals who switched to an accountable care organization showed no increased likelihood of receiving mental health treatment and exhibited no discernible improvements in symptoms compared to those in regular Medicare.

Johnston noted, "Overall, accountable care organizations had no effect on the quality of mental health care: All the outcome measures were zero except for one treatment measure for depression, which was actually worse."

However, Johnston hopes that this study will prompt policymakers to view mental-health quality measures in a more specific way amid the recent guidelines for mental health care that the Department of Health and Human Services released.

The study's findings were published in the journal Health Affairs.