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Published Online: 17 July 2017

Medicare Accountable Care Organizations and Antidepressant Use by Patients With Depression

Alisa B. Busch, M.D., M.S. [email protected], Haiden A. Huskamp, Ph.D., Amanda R. Kreider, B.S., B.A., and J. Michael McWilliams, M.D., Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 68, Number 11
https://doi.org/10.1176/appi.ps.201600538
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Abstract

Objective:

This study examined whether Medicare accountable care organization (ACO) programs were associated with early changes in antidepressant use or adherence among beneficiaries with depression.

Methods:

A difference-in-difference design was used to compare claims from Medicare fee-for-service beneficiaries (2009–2013) and ACO patients with those from local control groups. Outcome measures were total antidepressant days supplied, filling one or more antidepressant prescriptions, and proportion of days covered (PDC) by supply among antidepressant users (adherence).

Results:

Among antidepressant users, ACO contracts were associated with slight differential increases in PDC (.4–.8 percentage point, p≤.03), depending on ACO program and entry year. The proportion of patients with one or more prescriptions was unchanged or decreased slightly for ACO patients with depression, such that total supply did not consistently increase.

Conclusions:

Medicare ACO programs were associated with early modest increases in antidepressant adherence but not with increases in the proportion of patients with depression who received antidepressants.

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Information & Authors

Information

Published In

Go to Psychiatric Services
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Cover: Still Life of Fruit, anonymous, circa 1865. Gift of Edgar William and Bernice Chrysler Garbisch, National Gallery of Art, Washington, D.C.

Psychiatric Services
Volume 68 • Number 11 • November 01, 2017
Pages: 1193 - 1196
PubMed: 28712357

History

Received: 23 November 2016
Revision received: 14 April 2017
Accepted: 18 May 2017
Published online: 17 July 2017
Published in print: November 01, 2017

Keywords

  1. Quality of care
  2. Service delivery systems
  3. accountable care organizations
  4. Medicare

Authors

Details

Alisa B. Busch, M.D., M.S. [email protected]
The authors are with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. McWilliams is also with the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston.
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Haiden A. Huskamp, Ph.D.
The authors are with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. McWilliams is also with the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston.
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Amanda R. Kreider, B.S., B.A.
The authors are with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. McWilliams is also with the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston.
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J. Michael McWilliams, M.D., Ph.D.
The authors are with the Department of Health Care Policy, Harvard Medical School, Boston. Dr. Busch is also with McLean Hospital, Belmont, Massachusetts. Dr. McWilliams is also with the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston.
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Notes

Send correspondence to Dr. Busch (e-mail: [email protected]).

Competing Interests

Dr. McWilliams reports serving as a consultant to Abt Associates. The other authors report no financial relationships with commercial interests.

Funding Information

National Institute of Mental Health10.13039/100000025: T32MH019733
Assistant Secretary of Planning and Evaluation, Department of Health and Human Services: Contract No. HHSP233201300051C
This work was supported by the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services (contract HHSP233201300051C), and by the National Institute of Mental Health (T32 MH019733).

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