Report Offers Guidance to Mental Health Providers on Partnering With Accountable Care Organizations

Health care reform legislation passed last year has focused attention on two related models of integrated service delivery—the accountable care organization (ACO) and the patient-centered medical home—which will likely serve as foundational elements of future health care. Demonstration projects have shown that these models can improve the quality of care and patients' experience and reduce costs. However, neither ACOs nor health homes will be able to achieve these outcomes without effectively addressing mental health and substance use conditions.

To formally partner with these primary care-based entities, providers of mental health and substance abuse services will need to meet rigorous standards currently being developed by the National Committee for Quality Assurance (NCQA). To help providers understand options for structuring such partnerships and to ensure their readiness to participate in them, the National Council for Community Behavioral Health has released an 18-page report, Partnering With Health Homes and Accountable Care Organizations.

Although for many people ACOs and medical homes are concepts introduced under health reform, the report describes demonstration projects and other initiatives involving these models that have been under way for several years. The report emphasizes that this substantial body of work and the growing knowledge base make it very likely that these entities will play a central role in health care regardless of whether the reform law survives current legal challenges. The term “medical home,” which grew out of the pediatrics field, has been used for decades. As it is currently used, medical home refers to a model in which the patient has a designated primary care provider who is part of a care team with responsibility for coordinating the patient's overall health care needs. Medical homes are at the heart of ACOs. The report defines an ACO as “a structure through which a group of providers with shared governance takes responsibility for the management and coordination of a defined population's total spectrum of care.”

In October 2010 NCQA issued a draft of standards for ACOs for public comment. The standards outline criteria for achieving and maintaining recognition as an ACO at four levels—from a minimum to advanced level of capability—thereby providing a pathway for organizations to develop fully as an ACO. Also in October 2010 the American College of Physicians (ACP) released a position paper that informs specialists, such as behavioral health care providers, what they must do to partner effectively in a patient-centered health home. The National Council's report provides an overview of the NCQA criteria and the ACP principles and then examines them from the perspective of mental health and substance abuse treatment providers.

To ensure their readiness to participate in health homes and ACOs, providers of mental health and substance abuse services are urged to undertake a series of steps in four broad areas. First, it is important to prepare for participation in the larger health care field, which involves identifying community partners and building relationships, especially with primary care; developing competency in team-based care, particularly health homes; and instituting a measurement-based approach to care, such as by incorporating standardized clinical assessment tools into routine service delivery. Because ACOs and health homes seek to partner with “high-volume” specialty providers, mental health and substance use providers are advised to gather data on the population served and increase staff skills and knowledge in population health management, including wellness, prevention, and disease management approaches.

The second broad area of focus for provider organizations is to establish credentials as a high performer in terms of the “triple aim” of improving the quality of care and patients' experience and reducing costs. Steps toward this goal involve training staff to use quality assessment tools to track their performance, as well as assessing clients' experience of the care provided, including its patient centeredness and cultural competence. Providers are advised to document outcomes (mental health and substance abuse outcomes along with outcomes related to general health, such as body mass index) and to implement a plan for improving areas of weakness. Finally, to achieve the high performer goal, it is important to carefully evaluate the cost and value of the care provided.

Ensuring information technology (IT) readiness is the third critical area. IT systems must be able to support exchange of data within and outside the organization. They must also support use of data not only as a routine part of clinical work but also to facilitate performance review practices and to manage new payment structures (including linking performance to payment). Mental health and substance abuse service providers are also advised to reach out to community partners to begin forming local or regional health information exchanges.

Planning for an extended period of change is the fourth broad area—and one in which provider organizations may already have substantial experience. The report highlights the importance of implementing a change management plan, identifying key resources and a support network for staying current in regard to new and emerging practice and financing models, and investing in educating the organization's board and staff members about operational and clinical changes.

The full report is available on the National Council's Web site at www.thenationalcouncil.org/cs/partnerships_for_behavioral_health.