People with Mental Illness Don’t See Benefits from New Health Care Payments, Study Finds


New methods of paying for health care, designed to improve care while controlling costs, have failed to help a big segment of the population — those grappling with mental illness — a Harvard Medical School study says.

Published Monday in the journal Health Affairs, it said the Alternative Quality Contract, a payment system run by Blue Cross Blue Shield of Massachusetts, is not improving care or saving money for the mentally ill.


The contract works by paying doctors based on how well they meet a set of quality measures and stick to a certain budget. It differs from traditional fee-for-service payments, which compensate doctors based on the number of services and procedures.

While the new model has shown some success in slowing health care spending and improving care, that has not yet reached people with anxiety, depression, bipolar disorder, schizophrenia, and other mental illnesses, according to the study. Instead, doctors have spent more time and resources managing care for physical diseases like diabetes.

“Folks with mental illness, their care is plagued by fragmentation,” said Haiden Huskamp, a professor of health care policy at Harvard Medical School and an author of the study.

Huskamp and her coauthors examined claims data for the first three years of the Blue Cross contract and interviewed several Massachusetts health care providers. They found that providers were not initially focused on coordinating services for mental health patients. But that is changing.