Table 3:
Spending and Utilization by Attribution Status, 2009–2011
| Spending/Utilization Measure | All Beneficiaries | Attributed to a Medicare ACO? | |
|---|---|---|---|
| Yes | No | ||
| A. Any Mental Illness | |||
| Beneficiary-years | 7,210,176 | 3,847,630 | 3,362,546 |
| Annual spending ($), Mean (SD) | |||
| Total | 17,899 (34,221) | 17,797 (34,066) | 18,017 (34,398) |
| Acute care/critical access | 6,356 (18,165) | 6,430 (18,279) | 6,272 (18,033) |
| SNF | 1,590 (6,554) | 1,592 (6,559) | 1,589 (6,547) |
| Psychiatric hospital | 209 (2,312) | 203 (2,289) | 216 (2,338) |
| Annual utilization (/1000 beneficiaries), Mean (SD) | |||
| Emergency Dept. visits | 1,610 (3,212) | 1,617 (3,229) | 1,603 (3,194) |
| Acute/critical access admissions | 680 (1,422) | 679 (1,428) | 682 (1,416) |
| Prevention Quality Indicator overall composite admissions | 143 (554) | 140 (551) | 146 (557) |
| Ambulatory E&M visits | 12,469 (10,409) | 12,385 (10,350) | 12,564 (10,475) |
| Annual follow-up/readmission measure, Mean (SD) | |||
| Mental Health 7-day follow-up (proportion) | 0.38 (0.47) | 0.39 (0.47) | 0.36 (0.46) |
| Mental Health 30-day follow-up (proportion) | 0.68 (0.45) | 0.70 (0.45) | 0.65 (0.46) |
| 30 day readmission proportion | 0.11 (0.22) | 0.11 (0.22) | 0.11 (0.22) |
| B. Bipolar, Schizophrenia, or other Psychotic Disorders | |||
| Beneficiary-years | 2,948,579 | 1,575,711 | 1,372,868 |
| Annual spending ($), Mean (SD) | |||
| Total | 18,095 (31,820) | 17,880 (31,948) | 18,342 (31,671) |
| Acute care/critical access | 6,153 (16,932) | 6,172 (17,108) | 6,131 (16,728) |
| SNF | 1,685 (6,832) | 1,660 (6,777) | 1,713 (6,895) |
| Psychiatric hospital | 479 (3,511) | 465 (3,477) | 494 (3,549) |
| Annual utilization (/1000 beneficiaries), Mean (SD) | |||
| Emergency Dept. visits | 1,940 (3,836) | 1,947 (3,852) | 1,933 (3,819) |
| Acute/critical access admissions | 698 (1,505) | 692 (1,505) | 705 (1,505) |
| Prevention Quality Indicator overall composite admissions | 132 (542) | 128 (537) | 136 (549) |
| Ambulatory E&M visits | 12,012 (10,419) | 11,996 (10,436) | 12,030 (10,401) |
| Annual follow-up/readmission measure, Mean (SD) | |||
| Mental Health 7-day follow-up (proportion) | 0.38 (0.47) | 0.40 (0.47) | 0.36 (0.46) |
| Mental Health 30-day follow-up (proportion) | 0.68 (0.45) | 0.70(0.45) | 0.65 (0.46) |
| 30 day readmission proportion | 0.12 (0.24) | 0.12 (0.24) | 0.12 (0.24) |
| C. Depression w/o Bipolar, Schizophrenia, or other Psychotic Disorders | |||
| Beneficiary-years | 2,998,347 | 1,613,855 | 1,384,492 |
| Annual spending ($), Mean (SD) | |||
| Total | 18,924 (37,428) | 18,840 (36,889) | 19,022 (38,047) |
| Acute care/critical access | 6,883 (19,534) | 6,984 (19,725) | 6,764 (19,308) |
| SNF | 1,685 (6,693) | 1,694 (6,721) | 1,674 (6,659) |
| Psychiatric hospital | 28 (724) | 25 (697) | 31 (755) |
| Annual utilization (/1000 beneficiaries), Mean (SD) | |||
| Emergency Dept. visits | 1,462 (2,769) | 1,469 (2,780) | 1,454 (2,757) |
| Acute/critical access admissions | 717 (1,414) | 718 (1,424) | 716 (1,403) |
| Prevention Quality Indicator overall composite admissions | 160 (583) | 158 (583) | 163 (582) |
| Ambulatory E&M visits | 13,276 (10,617) | 13,164 (10,511) | 13,408 (10,738) |
| Annual follow-up/readmission measure, Mean (SD) | |||
| Mental Health 7-day follow-up (proportion) | 0.36 (0.48) | 0.38 (0.48) | 0.34 (0.47) |
| Mental Health 30-day follow-up (proportion) | 0.69 (0.46) | 0.71 (0.45) | 0.67 (0.47) |
| 30 day readmission proportion | 0.10 (0.21) | 0.10 (0.21) | 0.10 (0.21) |
SOURCE: Authors’ analysis of Medicare claims and enrollment data for 2009–2017. NOTES: Acute care includes critical access hospitals. SD = standard deviation, SNF = skilled nursing facility, E&M = evaluation and management visits. Observations in Hospital Service Areas below 25th percentile of ACO penetration excluded. Mental Health follow-up measures reflect proportion of index hospitalizations that result in mental health visit with 7 or 30 days of discharge. Attribution to Medicare ACOs based on plurality of E&M visits.