Dataset Information

Participation in Accountable Care Organizations Among Hospitals Offering Substance Use Disorder and Mental Health Services.

ABSTRACT: Accountable care organizations (ACOs) can potentially improve value in behavioral health care. However, little is known about the likelihood of ACO participation among hospitals with behavioral health services. The authors explore statistical predictors of ACO participation among hospitals, particularly among those offering behavioral health services. After adjusting for other hospital characteristics, the analysis found that behavioral health specialty hospitals were less likely to participate in an ACO and general medical-surgical hospitals with behavioral health services were more likely to participate, compared with general medical-surgical hospitals without behavioral health services. A better understanding is needed of barriers to ACO participation within behavioral health specialty hospitals and how ACO participation may affect quality of behavioral health care.

SUBMITTER: McDowell MJ

PROVIDER: S-EPMC6395515 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Participation in Accountable Care Organizations Among Hospitals Offering Substance Use Disorder and Mental Health Services.

McDowell Michal J MJ Busch Alisa B AB Sen Aditi P AP Stuart Elizabeth A EA Riedel Lauren L Barry Colleen L CL Huskamp Haiden A HA

Psychiatric services (Washington, D.C.) 20180828 11

Accountable care organizations (ACOs) can potentially improve value in behavioral health care. However, little is known about the likelihood of ACO participation among hospitals with behavioral health services. The authors explore statistical predictors of ACO participation among hospitals, particularly among those offering behavioral health services. After adjusting for other hospital characteristics, the analysis found that behavioral health specialty hospitals were less likely to participate ...[more]

PMID: 30152270

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Project description:ImportanceThe benefits of public payment policy may extend to private populations through "spillover" effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare payment systems could be a versatile policy tool in future reform efforts.ObjectivesTo determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients.DesignThis was a retrospective, longitudinal study which was conducted using Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015. We compared patients seen by physicians who participated in a Medicare ACO to patients whose physicians were not part of an ACO. We used a difference-in-differences (DIDs) design to test whether physician participation in an ACO was associated with reduced spending among their commercially insured patients. We also tested for heterogeneous effects: we assessed whether spillovers were larger among patients with clinical conditions (acute myocardial infarction, pneumonia, congestive heart failure) that have previously been targeted by Medicare payment programs.SettingThis was a population-based study of commercially insured patients in Michigan.ParticipantsPatients who experienced a significant clinical episode (eg, labor and delivery, acute myocardial infarction) between 2010 and 2015.ExposureOur patient-level exposure is treatment by a Medicare ACO-affiliated physician.Main outcomes and measuresMedical spending of 0-90 days and 91-365 days after a clinical episode.ResultsPatients in the exposure group (n=54,750) and in the control group (n=137,883) were similar in demographic characteristics of age, sex, and type of clinical episodes. Adjusted mean 90-day spending in the preexposure period was $21,292 among the exposure group and $21,157 among the comparison group; these means declined to $21,250 and $20,995 in the postperiod, yielding a DIDs estimate of $119 [95% confidence interval (CI), -$170 to $408]. Adjusted means for 91-365 days spending in the preperiod were $4258 among the exposure group and $4251 among the comparison group; these means rose to $4338 and $4421 in the postperiod, yielding a DIDs estimate of -$90 (95% CI, -$312 to $132). We also separately examined patients with conditions that have been targeted by other Medicare payment programs. Among these patients, 90-day spending did not differ between exposure and comparison groups (DIDs, -$223; 95% CI, -$2037 to $1591), although 91-365 days spending decreased among the exposure group with marginal statistical significance (DIDs, -$1160; 95% CI, -$2459 to $140).Conclusions and relevancePhysicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population.

Project description:Individuals with mental illness and substance use disorders smoke at elevated rates and tend to have greater difficulty quitting smoking as compared to the general population. Some believe that e-cigarettes may reduce harm associated with smoking, but little is known about e-cigarette use, perceptions, and motivations for their use among individuals with mental health and/or substance use disorders.Rates and correlates of e-cigarette use, perceptions, and sources of information about e-cigarettes among smokers seeking mental health and/or substance use services (N = 188) at the VA Connecticut Healthcare System were assessed via a brief survey. The Pearson ?(2) test of independence was used to compare veterans who currently used e-cigarettes with those who did not. Logistic regression was used to examine independent attitudinal differences controlling for potentially confounding variables.Participants were generally male (90%), Caucasian (54%), and older than 50 (69%), with high rates of at least one mental health condition (82%), at least one substance use disorder (73%), and comorbid mental health and substance use disorders (55%). A relatively high proportion of the sample (30.9%) used e-cigarettes. These participants, compared to those who did not use e-cigarettes, were more likely to have a mental health disorder and less likely to have a substance use disorder, started smoking later in life, spent less money on smoking, and were more likely to have tried to quit "cold turkey." Knowledge of e-cigarettes originated most often from TV, radio, or personal contacts. Respondents held generally positive perceptions and motivations regarding e-cigarette use (i.e., it is socially acceptable, may help reduce/quit smoking, less harmful to others). Despite positive attributions, rates of dual use of e-cigarettes and traditional cigarettes was high (86.2%), and very few people using e-cigarettes (6.9%) indicated that e-cigarettes actually helped them quit smoking, suggesting little related harm reduction.E-cigarettes are commonly used by smokers with mental health conditions and/or substance use disorders, a high-risk group that feels positive about e-cigarettes. However, positive regard of e-cigarettes did not appear to translate to ability to reduce or quit cigarette smoking. Safety and effectiveness research on e-cigarettes is urgently needed.

Dataset Information

Participation in Accountable Care Organizations Among Hospitals Offering Substance Use Disorder and Mental Health Services.

Publications

Participation in Accountable Care Organizations Among Hospitals Offering Substance Use Disorder and Mental Health Services.

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