Accountable Care Organizations (ACO) and Behavioral Health – A rose by any other name


If you’re in behavioral health care and have been hearing about ACOs, you might be thinking – hey, this sounds familiar. And it should. You see, mental health case managers already employ many of the same concepts being suggested within the ACO model. Don’t let the fancy acronym fool you – an ACO is basically a group of providers who manage the full continuum of care for a defined population. That group is responsible for both the costs and the quality of care for that population. The ACO is the organization that houses the teams that make up the Patient Centered Medical Home (PCMH). Add to this the notion of “bundled payments” or “case rates” and all of sudden we’re talking about concepts that community mental health care organizations deal with on a daily basis.

In fact, much of a behavioral health care organization’s structure is built around coordinating care between groups of providers and clients and community services to provide “wrap around” support so that clients can live healthy and productive lives. Furthermore, case managers often do this within a case rate model and by leveraging community resources to achieve a spectrum of care, within a conservative budget.

For behavioral health care providers, the real ah ha moment related to ACOs should be, “hey, I know how to do this!” What the ACO model does in fact, is take services that CMHC’s have been providing for years, adds to it the notion that primary care needs to be included within this spectrum of services, and then suggests that the PCMH is responsible for managing the full spectrum of care as well as the costs related to this person.

So if you’re a case manager, and know how to coordinate care so that a client with a specific condition or diagnosis gets a medication management appointment, a doctor’s appointment, or sees a specialist or a therapist, guess what – you know exactly how an ACO and PCMH is supposed to work. And you’re probably pretty good at it.