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Coordinated care model did not improve coordination, quality of mental health care

Individuals with mental health disorders did not experience improvement in coordination and quality of care following implementation of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract, though they did not experience decreased access to care as some predicted.

“The initial effort didn’t solve the problem of fragmented care for people with mental health conditions,” study researcher Haiden Huskamp, PhD, of Harvard Medical School, said in a press release. “We still need to do more to integrate the care that they get.”

Previous research has indicated the Alternative Quality Contract, implemented in 2009, slowed spending for overall health care and improved some measures of care quality for the general population.

Huskamp and colleagues assessed claims data from 2006 to 2011 to determine if implementation of the Alternative Quality Contract affected mental health service use, mental health care spending, total spending and quality of care. They interviewed providers and managers about the implementation process.

Colleen L. Barry

Interviews suggested organizations were not focused on mental health integration when the contract was first implemented. However, the researchers noted organizations now are considering how to develop new programs to better identify and support patients who would benefit from mental health and medical care integration, such as integrating social workers into treatment teams focused on nonmental health conditions like diabetes.

Huskamp and colleagues found that patients with mental illness were less likely to receive mental health services compared with control patients covered by the same insurer.

Further, spending did not change among individuals who utilized mental health services.

Patients with mental illness were less likely to benefit from improved quality of care, according to researchers. This may be due to contract incentives regarding prevention and treatment of chronic illnesses.

Providers under the contract were more likely to implement certain diabetes management approaches for contract patients compared with Blue Cross Blue Shield enrollees not under the contract. These improvements were not found among contract enrollees with both diabetes and concurrent mental illness, according to researchers.

“In order to take advantage of the transformative power of coordinated care, we need to make sure that the incentives and quality measures we use address the needs of this crucial population,” Colleen L. Barry, PhD, of Johns Hopkins Bloomberg School of Public Health, said in the release.

Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.