Journal of General Internal Medicine

, Volume 34, Issue 12, pp 2898–2900 | Cite as

Accountable Care Organizations’ Performance in Depression: Lessons for Value-Based Payment and Behavioral Health

  • Nathaniel Z CountsEmail author
  • Glenda Wrenn
  • David Muhlestein


Value-based payment initiatives, such as the Medicare Shared Savings Program (MSSP), offer the possibility of using financial incentives to drive improvements in mental health and substance use outcomes. In the past 2 years, Accountable Care Organizations (ACOs) participating in the MSSP began to publicly report on one behavioral health outcome—Depression Remission at Twelve Months, which may indicate how value-based payment incentives have impacted mental health and substance use, and if reforms are needed. For ACOs that meaningfully reported performance on the depression remission measure in 2017, the median rate of depression remission at 12 months was 8.33%. A recent meta-analysis found that the average rate of spontaneous depression remission at 12 months absent treatment was approximately 53%. Although a number of factors likely explain these results, the current ACO design does not appear to incentivize improved behavioral health outcomes. Four changes in value-based payment incentive design may help to drive better outcomes: (1) making data collection easier, (2) increasing the salience of incentives, (3) building capacity to implement new interventions, and (4) creating safeguards for inappropriate treatment or reporting.


value-based payment payment reform depression mental health behavioral health 


Authors’ Contributions

Mr. Counts led the initial drafting, and all authors offered critical revisions of the manuscript for important intellectual content. All authors had access to the data, which is publicly available.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Nathaniel Z Counts
    • 1
    Email author
  • Glenda Wrenn
    • 2
  • David Muhlestein
    • 3
  1. 1.Mental Health AmericaAlexandriaUSA
  2. 2.Morehouse School of MedicineAtlantaUSA
  3. 3.Leavitt PartnersSalt Lake CityUSA

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