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The Early Impact of the "Alternative Quality Contract" on Mental Health Service Use and Spending in Massachusetts

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Patients with mental health problems are often poorly served by the health care system, partly because of a shortage of behavioral health providers and partly because of a lack of focus on behavioral health needs in primary care practices. This has serious consequences for patients with mental health problems as well as chronic disease, since one condition can exacerbate the other. Accountable care organizations, which reward providers for improving health outcomes and lowering spending, may be part of the solution, some experts say. The authors of this Commonwealth Fund–supported study sought to determine whether one such accountable care program—the Alternative Quality Contract (AQC), launched by Blue Cross Blue Shield (BCBS) of Massachusetts—led to changes in use of mental health services.

What the Study Found

Enrollees in BCBS HMOs or point-of-service plans that were participating in the AQC were found to be slightly less likely to use mental health services than patients enrolled in non-AQC organizations. Enrollees in AQC organizations also had small declines in total health care spending, though no change was found in mental health spending. For AQC enrollees who had mental health conditions and chronic illnesses, there was no significant improvement in performance metrics for diabetes or cardiovascular disease.

According to interviews with leaders at AQC organizations and specialty mental health providers, little was done to integrate mental health care with primary care during the contract’s initial years. Limited mental health provider capacity was also cited as a major barrier. Interviewees further noted that only two of the AQC’s 64 measures were devoted to behavioral health.


Several organizations are now in the early stages of integrating primary care with behavioral health services—like embedding behavioral health clinicians into primary care practices. The behavioral health field must also continue to develop new, meaningful measures, the authors say.

Publication Details



C. L. Barry, E. A. Stuart, J. M. Donohue et al., "The Early Impact of the 'Alternative Quality Contract' on Mental Health Service Use and Spending in Massachusetts," Health Affairs, Dec. 2015 34(12):2077–85.