Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
Department of Psychiatry, Geisel School of Medicine at Dartmouth.
Medicine (Baltimore). 2021 Jul 9;100(27):e26539. doi: 10.1097/MD.0000000000026539.
Collaborative care - primary care models combining care management, consulting behavioral health clinicians, and registries to target mental health treatment - is a cost-effective depression treatment model, but little is known about uptake of collaborative care in a national setting. Alternative payment models such as accountable care organizations (ACOs), in which ACOs are responsible for quality and cost for defined patient populations, may encourage collaborative care use.Determine prevalence of collaborative care implementation among ACOs and whether ACO structure or contract characteristics are associated with implementation.Cross-sectional analysis of 2017-2018 National Survey of ACOs (NSACO). Overall, 55% of ACOs returned a survey (69% of Medicare, 36% of non-Medicare ACOs); 48% completed at least half of core survey questions. We used logistic regression to examine the association between implementation of core collaborative care components - care management, a consulting mental health clinician, and a patient registry to track mental health symptoms - and ACO characteristics.Four hundred five National Survey of ACOs respondents answering questions on collaborative care implementation.Only 17% of ACOs reported implementing all collaborative care components. Most reported using care managers (71%) and consulting mental health clinicians (58%), =just 26% reported using patient registries. After adjusting for multiple ACO characteristics, ACOs responsible for mental health care quality measures were 15 percentage points (95% CI 5-23) more likely to implement collaborative care.Most ACOs are not utilizing behavioral health collaborative care. Including mental health care quality measures in payment contracts may facilitate implementation of this cost-effective model. Improving provider capacity to track and target depression treatment with patient registries is warranted as payment contracts focus on treatment outcomes.
协作式护理 - 将护理管理、咨询行为健康临床医生和患者登记册相结合以针对心理健康治疗的初级保健模式 - 是一种具有成本效益的抑郁症治疗模式，但在全国范围内，协作式护理的采用情况知之甚少。责任医疗组织（ACO）等替代支付模式，其中 ACO 对特定患者群体的质量和成本负责，可能会鼓励协作式护理的使用。确定 ACO 中协作式护理实施的流行率，以及 ACO 结构或合同特征是否与实施相关。2017-2018 年全国 ACO 调查（NSACO）的横断面分析。总体而言，55%的 ACO 回复了调查（69%的医疗保险，36%的非医疗保险 ACO）；48%的 ACO 完成了至少一半的核心调查问题。我们使用逻辑回归来检查实施核心协作式护理组件（护理管理、咨询心理健康临床医生和患者登记册以跟踪心理健康症状）与 ACO 特征之间的关联。405 名回答协作式护理实施问题的全国 ACO 调查受访者。只有 17%的 ACO 报告实施了所有协作式护理组件。大多数报告使用护理经理（71%）和咨询心理健康临床医生（58%），只有 26%的 ACO 报告使用患者登记册。在调整了多个 ACO 特征后，负责精神保健质量措施的 ACO 实施协作式护理的可能性高 15 个百分点（95%CI 5-23）。大多数 ACO 并未利用行为健康协作式护理。在支付合同中纳入精神保健质量措施可能有助于实施这种具有成本效益的模式。随着支付合同侧重于治疗结果，有必要提高提供者通过患者登记册跟踪和针对抑郁症治疗的能力。
