Behavioral Health and ACO Statistics

As organizations take on financial risk and transition away from fee-for-service to value-based models of care, focus has intensified on how to effectively manage the riskiest and most expensive patients. In this value-based world, patient engagement, chronic disease management, and proactive care measures are paramount. Behavioral health disorders are widespread, and the management of these patients is critical to a successful population health strategy. Not only is providing high quality care for patients with behavioral health needs – such as depression, anxiety, and substance abuse – the right thing to do for patient care, but it’s also compelling from a business perspective.

Why ACOs need behavioral health data

Approximately 43.6 million U.S. adults (18.1%) have a mental illness (National Institute of Health). According to a Milliman American Psychiatric Association Report, the “medical costs for treating those patients with chronic medical and comorbid mental health/substance use disorder (MH/SUD) conditions can be 2-3 times as high as those beneficiaries who don‘t have the comorbid MH/SUD conditions.”

ACOs have a particular imperative to manage this risky and costly patient population. However, Healthcare IT News reports that “only 14 percent of accountable care organizations have integrated behavioral health services with primary care in their organizations, while one-third have no formal relationship.” This lack of partnership can be damaging for patients and can lead to disjointed patient care. The Agency for Healthcare Research and Quality reported (2010) that mental health and substance abuse cases accounted for 1 in 8 Emergency Room (ER) visits in the United States. ERs are often not well equipped to manage behavioral health patients, who often require long-term provider support and careful follow-up.

These trends in disjointed care are also reflected in low levels of data integration from ACOs.  ACOs success hinges upon the use of high quality patient data yet the majority of ACOs have not integrated data from behavioral health specialists. According to a survey of 68 ACOs conducted by Premier and health IT collaborative eHealth Initiative, “fifty-three percent of ACOs have not integrated data from behavioral-health providers.” The lack of integrated data can have a profound impact on care quality. At Arcadia, we fully believe that better data supports better care. When providers have actionable data during a patient visit, they can provide more customized care, which leads to improved outcomes and increased patient satisfaction.  In addition, accurate aggregated data provides important trending information to the ACO medical leadership, and suggests areas for further targeted interventions.

Why ACOs struggle to integrate behavioral health data

There are two critical factors that help explain why behavioral health data integration has been so difficult for ACOs: incentives and regulation.

Meaningful Use (MU) requirements have spurred furious technology investments over the past several years, but behavioral health providers were largely left out. A report from Center for Health Care Strategies notes that, “while the uptake of electronic medical records (EMR) by medical providers has risen significantly in recent years, use is dramatically lower among behavioral health providers and only a small proportion are connected to Health Information Exchanges (HIE), relative to their counterparts in the physical health arena.” Without stronger financial incentives, many providers will find the upfront technological investment too steep.

Another hurdle for ACOs are the strict patient privacy laws for behavioral health diagnoses. Those with behavioral health issues may face stigma from employers, friends and family. The government protects this type of sensitive patient information through 42 Code of Federal Regulations (CFR) Part II, which requires additional patient consent before health information can be shared between treating providers. These stricter regulations often lead to incomplete patient records. “Many states are encountering obstacles in using HIE and all-payer claims databases to facilitate data sharing with ACOs and behavioral health providers within 42 CFR Part II requirements” (Center for Health Care Strategies Report).

While ACOs face real obstacles to integrate data from behavioral health providers, this data can support better patient care, and provide organizations insight to the utilization and cost of these services. In a world of value-based payments, tackling this important patient population will be key for successful population health management. Organizations taking steps to integrate this data will provide better patient care and grow their bottom line.

Tessa Geron is a business analyst at Arcadia with a strong interest in behavioral health and managed care.  Dr. Rich Parker, chief medical officer, and Ryan Rubino, principal consultant, contributed to this post.

April 13, 2016