Table 1.
Characteristics of ACOs fully implementing collaborative care compared to those either partially or not implementing.
| Whole sample | Collaborative care implementation | ||||
| None (0 strategies) | Partial (1–2 strategies) | Full (3 strategies) | |||
| (405 ACOs, 100%) | (65 ACOs, 16%) | (271 ACOs, 67%) | (69 ACOs, 17%) | P | |
| Contract characteristics | |||||
| Payer, N (%) | |||||
| (Most ACOs have contracts with 2 or more payers) | |||||
| Has a Medicare contract | 338 (83%) | 56 (86%) | 226 (84%) | 56 (80%) | .62 |
| Has a commercial contract | 295 (73%) | 40 (62%) | 201 (74%) | 54 (77%) | .08 |
| Has a Medicaid contract | 96 (24%) | 6 (9%) | 68 (25%) | 22 (31%) | .01 |
| Financial characteristics, N (%) | |||||
| Shares financial risk in any contract∗ | 149 (37%) | 16 (25%) | 98 (36%) | 35 (50%) | .01 |
| Previous experience in risk-based contracts | 257 (64%) | 35 (54%) | 175 (66%) | 47 (69%) | .15 |
| Mental health contract characteristics, N (%) | |||||
| (included in non-Medicare contracts) | |||||
| Includes mental health services in total cost of care calculation | 163 (43%) | 17 (29%) | 111 (44%) | 35 (52%) | .02 |
| Includes mental health in quality performance measures | 134 (34%) | 7 (11%) | 99 (37%) | 28 (41%) | <.01 |
| Carves out mental health services from contract | 84 (21%) | 7 (11%) | 57 (21%) | 20 (29%) | .04 |
| Organizational characteristics | |||||
| Leadership, N (%) | |||||
| Physician-led ACO∗ | 143 (38%) | 36 (56%) | 83 (33%) | 24 (39%) | <.01 |
| Partnerships, N (%) | |||||
| Includes specialty behavioral health provider in ACO network∗ | 54 (13%) | 3 (5%) | 35 (13%) | 16 (23%) | .01 |
| Includes federally qualified health center (FQHC) in ACO network | 104 (26%) | 14 (22%) | 69 (26%) | 21 (31%) | .50 |
| Includes academic medical center in ACO network | 72 (18%) | 3 (5%) | 52 (21%) | 14 (21%) | .02 |
| Includes public hospital in ACO network | 45 (11%) | 8 (13%) | 26 (10%) | 11 (16%) | .33 |
| Size mean (95% CI) | |||||
| Number of clinicians in ACO network | 797 (679–915) | 408 (218–599) | 855 (710–1000) | 935 (595–1275) | .01 |
Notes: This figure shows data from the 405 ACOs who reported their use of collaborative care strategies in the 2017–2018 NSACO. We imputed missing covariate data using multiple imputation. We considered all ACOs participating in Medicare Shared Savings Program Tracks 1+, 2, or 3 and those participating in Medicare's Next Gen ACOs as sharing financial risk, in addition to those who reported taking on downside risk in their commercial or Medicaid contracts. We considered organizations physician-led if they reported physician leadership and did not include a hospital in their network. Specialty behavioral health provider refers to community mental health centers and addiction treatment centers. We used an F tests for significance testing between levels of collaborative care implementation. ACO = accountable care organization; FQHC = federally qualified health center; NSACO = National Survey of ACOs. Source: 2017–2018 NSACO.