UMass Amherst Will Lead First Study on Impact of Medicaid ACOs on Mental Health Care for Children in Massachusetts

UMass Amherst public health researcher Dr. Sarah Goff has been awarded a five-year, $2.2 million grant from the National Institutes of Health (NIH) to examine the impact of Medicaid accountable care organizations (ACOs) on the quality and outcomes of behavioral/mental health care for children in Massachusetts. 

ACOs are the value-based health care delivery model designed to reduce Medicare and Medicaid costs while improving coordination and quality of care.

“Fundamental changes in health care are needed to address socioeconomic and racial/ethnic disparities in behavioral health care quality and outcomes for children in vulnerable populations,” the grant summary states.

In the past decade, the prevalence of mental health disorders among children has climbed in Massachusetts, says Goff, lead investigator who is a practicing pediatrician and internist and associate professor/chair of health promotion and policy in the School of Public Health and Health Sciences.

Depression, anxiety and suicidality have increased across all demographic groups, with youth identifying as LGBTQ+ and youth in other minoritized populations experiencing some of the highest increases. Massachusetts struggles to provide care for children with mental health disorders, Goff notes, and alternative models of health care delivery and finance have the potential to improve care, but ACOs’ impact on behavioral health care for children is not clear. 

In 2016 in Massachusetts, one in six children, ages 6-17, had a mental health diagnosis, and that rate increased to an estimated one in four during the COVID-19 pandemic.  

“There’s a huge need, an increasing need, for mental/behavioral health care for children and it can be really challenging to access for a lot of people,” Goff says. 

Goff’s new research is modeled on her ongoing, NIH-funded examination of the impact of ACOs on asthma care in children insured by Medicaid. She is collaborating with co-lead investigator Kimberley Geissler, a health economist and former UMass Amherst associate professor who now works at Baystate Health as the chief of health equity and health services research; pediatric psychiatrist Dr. Barry Sarvet, chair of psychiatry at UMass Chan Medical School-Baystate; and Jessica Pearlman, director of research methods programs at the UMass Amherst Institute for Social Science Research, who is working on the study’s statistical design.  

The researchers will use an innovative mixed methods approach to investigate how the launching of 17 new Medicaid ACOs in Massachusetts in 2018 may have impacted mental health care for children.  

The ACOs have different organizational features, such as size, hospital- vs physician-led and age mix. Studies of adult populations suggest that ACOs with certain organizational features may improve quality of care for chronic diseases. Goff’s project will be the first study to focus on the associations between this new group of ACOs and the quality and outcomes of care for this large, higher-risk population of children with mental health disorders.  

The researchers will analyze claims data and survey data collected by MassHealth, the Medicaid administrator in Massachusetts, and will conduct interviews of parents, ACO leaders and mental health and primary care providers. “It’s a nice government-academic partnership,” Goff says. 

Findings from the study can inform providers, payers and policy makers responsible for the care of vulnerable populations of children with mental health disorders. 

“Efforts to address the shortcomings of the specialty behavioral care system, such as integrating behavioral care into pediatric primary care settings, and state programs that offer telephonic psychiatry consultation to pediatricians, have helped improve care,” the grant summary states, “but immense gaps in care and disparities persist.”