ACO Care For The Seriously Ill.

Abstract

Letters Health AffairsVol. 38, No. 11: Household Costs, Food & More ACO Care For The Seriously IllWilliam Holcomb AffiliationsBehavioral Health Concepts Emeryville, CaliforniaPUBLISHED:November 2019Free Accesshttps://doi.org/10.1377/hlthaff.2019.01113AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSAccountable care organizationsSerious mental illnessBehavioral health careTwo recent articles in Health Affairs describe challenges that accountable care organizations (ACOs) face in providing care for people with serious illness. First, William Bleser and coauthors (Jun 2019) argue that ACOs must first establish a reasonable business case for caring for the seriously ill. Only 8–21 percent of surveyed ACOs actually implemented care initiatives for the seriously ill. Impediments to doing so included workforce shortages and costs for information technology. Shared savings from caring for the most ill were viewed as uncertain.Second, Kristin Peck and coauthors (Jul 2019) report that ACOs are not ready to take the risk of needed investments in care innovation for the seriously ill. These challenges are even more ominous when one considers care for serious mental illness, which is the largest and fastest-growing category of health care expenditures in the US.As states debate and refine their Medicaid managed care systems, novel approaches are needed that address disability from serious mental illness. Prospective payment systems that do not address shortages of professional staff and real costs of evidence-based services will not reduce the burden and suffering of mental illness. These services go beyond emergency department, hospital, and outpatient care and include psychosocial rehabilitation, supportive housing, supportive employment, and assisted community treatment. Supply-side financing that adequately pays providers for evidence-based care is desperately needed.1 Managed care systems that overincentivize efficiency can lead to adverse patient selection and the failure to offer evidenced-based services. Such financing models inadequately serve people with serious mental illness and only increase their inappropriate use of emergency services, homelessness, and criminalization.NOTE1 McGuire TG. New financing models in behavioral health: a recipe for efficiency or under-provision? In: Goldman HH, Frank RG, Morrissey JP, editors. Palgrave handbook of American mental health policy. Cham (Switzerland): Palgrave Macmillan; 2020. p. 639–57. Crossref, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 4 November 2019 Information© 2019 Project HOPE—The People-to-People Health Foundation, Inc.PDF downloadRelated articlesACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities03 Jun 2019Health AffairsACO Contracts With Downside Financial Risk Growing, But Still In The Minority01 Jul 2019Health Affairs