How ACOs Are Integrating Behavioral Health Services

Many Accountable Care Organizations (ACOs) are eyeing behavioral health integration to drive down the cost of care, boost accessibility and improve overall health outcomes.

ACOs work outside the traditional fee-for-service model. Instead, provider reimbursement is tied to the quality of care and overall spending reduction.

While several studies have documented the impacts of behavioral health on a patient’s physical health, each ACO is taking its own approach to integration. Some have implemented co-location, while others have partnered with tech companies to provide their patients with virtual care options.

And these efforts have been years in the making.

“ACOs are increasingly recognizing the importance of addressing behavioral health care needs to help control utilization and spending, but they have had mixed success in trying to integrate behavioral health into and coordinate it with primary care,” authors of a 2016 Health Affairs study wrote.

The Health Affairs study found that the most common integrated care approach is to have co-located primary care and behavioral health providers. Another popular approach ACOs are taking is to provide members with “short-term behavioral health support while increasing the strength of their referral network for long-term treatment.”

There is increasing pressure on ACOs to integrate care now, with some states even mandating that Medicaid ACOs integrate behavioral health services.

For example, in Massachusetts, its two Medicaid ACOs are required to have coordinated behavioral health services. One does so through contracting with a managed care organization to create an entire network of providers; the other contracts with Massachusetts Behavioral Health Partnership.

While ACOs might be early adopters in the collaborative care model, the organizations could help pave the path for others.

Behavioral Health Business compiled three examples of how ACOs are integrating behavioral health in innovative ways.

A tech-focused approach 

Nonprofit health system Atlantic takes a population-health-based approach to care for its ACO members and tries to take a more proactive than reactive approach to care, Dr. James Barr, VP of physician value-based programs and CMO of ACOs at Atlantic, told BHB. And it had a successful track record with Medicare and commercial payers.

But during the COVID-19 pandemic, the system saw some patients struggling.

“We still had the underlying problem that a lot of patients, because of the behavioral health conditions, whether diagnosed or undiagnosed, were not having good outcomes,” Barr said. “They wouldn’t follow the doctor’s recommendations. They wouldn’t take their medications, and they wouldn’t go for their screening.”

Underlying behavioral health conditions often led to more emergency room visits for mental or physical health conditions, exacerbated by non-compliance.

Atlantic Health System has more than 400 sites of care across New Jersey, Pennsylvania and New York. It has a workforce of 19,000 team members and 4,800 affiliated physicians.

“So behavioral health has a huge influence on the outcomes of patients,” Barr said. “We felt that we needed to be more aggressive in the different tools, technologies and analyses that we use to help these populations.”

To help patients expand access to care, it decided to take a tech-based approach and team up with digital health company Neuroflow to use a collaborative care model to integrate behavioral health services across Atlanctic’s 16 ACO sites.

The partnership allows clinicians to use NeuroFlow’s registry and caseload management tools to help track and measure members’ progress. It also includes AI-backed screening tools to help pinpoint patients that might need services.

Members needing services can tap into the technology for customized coaching, education, care plans and motivational tools. Members can see a virtual behavioral health provider through the vendor if a patient needs to talk to a therapist.

Atlantic rolled out the new offering to about 25,000 patients this spring, but the plan is to increase that in the third and fourth quarters of the year to include 50,000 patients.

But more than just ACOs could benefit from a collaborative care model or technology innovations.

“In some ways, the ACO has become an incubator for health systems. The health system then picks up the models here because they see how immensely beneficial they are,” Dr. Tom Zaubler, chief medical officer of Neuroflow, told BHB. “ACOs can be the leading edge of some of the adoption of innovative technologies and models of care, like collaborative care. Then what we’re seeing is that health systems, then, say, ‘Wow, this is really a great model.'”

This collaboration demonstrates one way that ACOs can tap outside partners and use technology to support their services, even if they don’t have in-house co-locations.

ACO REACH collaborations

Last year, the U.S. Centers for Medicare & Medicaid Services (CMS) announced a new model called ACO Realizing Equity, Access and Community Health (REACH). The new model is focused on equity, access and care coordination, including for those in underserved communities.

Some participants see this as a way to help boost behavioral health integration.

One such company is hybrid care company One Medical.

Amazon-owned One Medical provides in-person and behavioral health care for its members. The company acquired Medicare-focused Iora Health for $2.1 billion two years ago.

Today, most of its Medicare business, including its ACO REACH program, falls under its Iora subsidiary.

One of the main ways One Medical integrates care is by having behavioral health specialists and coaches on their staff to assist members.

About 40% to 50% of Iora’s patients are enrolled in an ACO REACH, but the program helps the larger organization find gaps in care and innovate. It also helps put a focus on equity and access to services.

“Iora has always had a behavioral health specialist and health care coaching aspect to their care model. They believe – and I believe – that you can’t separate behavioral and mental health, at least not acutely serious behavioral or mental health, from primary care,” Andrew Van Ostrand, head of government affairs at One Medical, previously told BHB. “The challenge is that under a non-ACO REACH capitated risk-sharing arrangement, under the legacy fee-for-service model, the fee-for-service model didn’t allow for a collaborative care approach.”

The ACO REACH program is still very much in its infancy, but this program demonstrates that behavioral health could be a major component moving forward.

It also shows one path forward to addressing behavioral health access and equity questions.

A home-based approach

Massachusetts-based Innovive teams up with ACOs and Medicaid to help provide in-home skilled nursing to patients with serious mental illness (SMI).

Its model marries together physical and behavioral health needs. It provides skilled nursing as its primary service but also offers physical therapy, occupational therapy and home health aides.

Although it doesn’t directly staff behavioral health providers, its staff are specifically trained to work with patients with SMI and chronic conditions. The model considers that folks with SMI often have a harder time managing chronic conditions.

Innovive goal is to help keep patients at risk out of the hospital and help patients see health improvements.

Although Innovive is not an ACO, it demonstrates how ACOs can collaborate with outside organizations to improve a patient’s overall health while accounting for behavioral health concerns.