Effect of Medicaid Accountable Care Organizations on Behavioral Health Care Quality and Outcomes for Children

PROJECT SUMMARY One in six children aged 6-17 years had a behavioral health (BH) diagnosis in 2016 and rates have continued to increase. Limited access to BH services has long presented challenges for most children. Efforts to address the shortcomings of the specialty BH care system, such as integrating BH care into pediatric primary care settings, and state programs that offer telephonic psychiatry consultation to pediatricians, have helped improve care, but immense gaps in care persist. Accountable care organizations (ACOs) incentivize care integration and population health, which promotes community-health care linkages and care coordination. The innovative reform introduced by ACOs has the potential to improve BH care delivery, but their impact for pediatric populations is largely unknown. Studies of adult populations suggest that ACOs with certain organizational features (e.g., type of contract) may improve quality of care for chronic diseases but the few studies of the impact of ACOs on quality of care and outcomes for children have not focused on this large population of children with BH disorders. This study will be the first to address this critical gap in knowledge by taking advantage of the natural experiment taking place in Massachusetts (MA), a state with a high prevalence of children with BH diagnoses. In 2018, MA, launched 17 new Medicaid ACOs with heterogeneous organizational features (e.g., size; physician vs. hospital-led; age mix). We will leverage MA’s innovative Medicaid ACO ‘experiment’ to address the following aims using mixed methods: 1) Evaluate the impact of ACOs on BH care quality, outcomes, and disparities for Medicaid-insured children; 2) Discern how ACO heterogeneity modifies ACOs’ effects on BH quality and outcomes; 3) Determine the relationship between parent reported experience with their child’s BH care and organizational features of the Medicaid ACOs. Fundamental changes in healthcare are needed to address disparities in BH care quality and outcomes for children. Our innovative mixed methods approach to examining the association between exposure to a new heterogeneous group of Medicaid ACOs and BH care and outcomes uses state-level administrative claims and survey data and key informant interviews with ACO leaders and parents to begin to address this large gap in knowledge. This new information is expected to benefit providers, payers, and policy makers responsible for the care of children with BH disorders.