An Examination of Behavioral Healthcare Integration in Medicare Accountable Care Organizations (ACOs)

The Program Support Center on behalf of the Assistant Secretary for Planning and Evaluation (ASPE) within the Department of Health and Human Services intends to negotiate and award a contract to Harvard University on a sole source basis under the authority of FAR 6.302-1. This project will examine how the Medicare Shared Savings Program (MSSP) and Pioneer Program Accountable Care Organizations (ACOs) address the behavioral health care needs of Medicare beneficiaries. It will assess the degree to which Medicare ACOs identify behavioral health conditions among their assigned beneficiaries, provide care for these conditions, and incorporate behavioral health providers in their organizations. In addition, this project will examine the effect of ACO enrollment on access to care, quality of care, patient satisfaction, and spending among beneficiaries with behavioral health conditions. The period of performance for the project shall be 24 months. Section 3022 of the Affordable Care Act (ACA) established Accountable Care Organizations (ACOs) as a means to improve care and health outcomes for Medicare enrollees, and reduce health care spending. ACOs are groups of healthcare providers that join together and accept responsibility for a set of patients. Medicare fee-for-service beneficiaries enrolled in both Medicare Part A and Part B are assigned to ACOs. There are over 250 Medicare ACOs alone to which over four million beneficiaries have been assigned nationwide. Research has shown that collaborative care and integrated care models analogous to ACOs are cost-effective and can significantly reduce symptoms, and improve outcomes such as medication adherence for individuals with behavioral health diagnoses. However, it is uncertain if behavioral healthcare will be a priority for ACOs because financial incentives are tied to achieving savings while meeting performance standards and there is only one required behavioral health reporting requirement (depression screening). This study will determine the degree to which Medicare ACOs address the behavioral healthcare needs of their assignees and the impact of ACO assignment on outcomes. This will also be the first study to evaluate patient satisfaction and other outcomes for Medicare enrollees in ACOs with behavioral health conditions. The study will address the following specific questions: Characteristics of ACOs 1. How are ACOs organized to care for individuals with behavioral health diagnoses and/or co-morbid conditions? For example, does the ACO offer the full range of services from outpatient substance abuse treatment to inpatient hospitalization? 2. How many providers who specialize in behavioral healthcare are in the ACO? Access and Quality 1. Compared to non-ACO enrolled Medicare beneficiaries with a behavioral health diagnosis, are similar ACO enrollees more or less likely to receive behavioral healthcare in accordance with evidence-based practices (EBPs) or practice guidelines? 2. Are ACO enrollees receiving screening and referral to treatment for substance abuse, anxiety and/or other behavioral health conditions? 3. To what degree are beneficiaries with a behavioral health diagnosis receiving behavioral healthcare from providers outside of the ACO? Outcomes 1. Compared to non-ACO enrolled Medicare beneficiaries with a behavioral health diagnosis, do similar ACO enrollees experience better outcomes (e.g., patient satisfaction, lower re-hospitalization, fewer ER visits, medication adherence, etc.)? 2. Do ACO enrollees have lower or higher amounts of health services utilization (e.g., therapy/counseling visits, primary care visits, inpatient care, etc.)? 3. Compared to non-ACO enrolled Medicare beneficiaries with a behavioral health diagnosis, do ACO enrollees have lower or higher aggregate Medicare spending? The study will require the use of individual-level Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data survey data linked to claims data, and the use of Medicare claims data exclusively. The CAHPS data have information on beneficiary assignment to ACOs, but are not currently released to the public. In addition, CMS does not identify ACOs, ACO providers or ACO enrollees in Medicare claims. Therefore, this project will require a specialized methodology for identifying these entities and ACO enrollees in the claims data. Dr. Michael McWilliams of Harvard University is the only individual that has access to both individual-level CAHPS survey data and a methodology for identifying ACO enrollees. This methodology has been validated in a study ("Post-Acute Care and ACOs - Who Will Be Accountable?") published in a peer reviewed journal, Health Services Research. No solicitation document is available. All responsible sources that have the requisite qualifications to perform the work described above may submit a statement of capabilities electronically to James Horkan at james.horkan@psc.hhs.gov. Responses must be double-spaced with 1" margins on all sides and use a standard font no smaller than 12 point. The response must be sequentially numbered, beginning on the first page after the table of contents. Responses are due by August 12, 2013 by 4:00 pm EST. Responses will not be accepted after the due date. If no capability statements are received which specifically demonstrate the ability to perform the requirements above, the Government shall proceed with negotiating a sole source contract to Harvard University.