Cost Sharing for Substance Abuse and Mental Health Services in Managed Care Plans

Hodgkin, Dominic; Horgan, Constance M.; Garnick, Deborah W.; Merrick, Elizabeth L.

doi:10.1177/1077558702250248

Cited by 15 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in benefit design implemented by insurers and employers in response to MHPAEA have been documented in several publications (Ettner, 2016; Goplerud, 2013; Hodgkin et al, 2003; United States Government Accountability Office, 2015). These analyses provided some evidence that among pooled samples of carve-in and carve-out plans, certain insurance benefit design features did become more generous following MHPAEA implementation (in particular, quantitative treatment limits were removed), suggesting that one might expect a demand response.…”

Section: Literature Reviewmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Ettner

Harwood

Thalmayer

et al. 2016

Journal of Health Economics

View full text Add to dashboard Cite

Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008-13 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-13) periods. The sample included 1,812,541 individuals ages 27-64 (49,968,367 person-months) in 10,010 Optum “carve-out” plans. Two-part regression models with Generalized Estimating Equations were used to estimate expenditures by payer and outpatient, intermediate and inpatient service use. We found little evidence that MHPAEA increased utilization significantly, but somewhat more robust evidence that costs shifted from patients to plans. Thus the primary impact of MHPAEA among carve-out enrollees may have been a reduction in patient financial burden.

show abstract

Section: Literature Reviewmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Ettner

Harwood

Thalmayer

et al. 2016

Journal of Health Economics

View full text Add to dashboard Cite

show abstract

“…In managed care plans nationally, coinsurance and copayment levels for mental health and substance abuse were respectively 184% and 142% higher in 1999 than were rates for physical health (30). Despite the high levels of cost-sharing, few studies since the HIE have reported on its impact on mental health and substance abuse care.…”

Section: Behavioral Health Care Cost-sharingmentioning

confidence: 99%

Cost-Sharing: A Blunt Instrument

Remler

Greene

2009

Annu. Rev. Public Health

View full text Add to dashboard Cite

Cost-sharing is a health care cost-containment technique in which health care services are partially paid for by patients out of pocket. Costsharing can reduce non-cost-effective care, but it can also undermine the financial protection and access values of health insurance. We review the empirical evidence published since the mid-1980s about cost-sharing's effect on utilization, expenditures, health, and adverse consequences, including how the effects vary by form of care, by health status, and by sociodemographic characteristics. Some cost-sharing, such as emergency department copayments, reduces utilization without any harmful effects, whereas other cost-sharing reduces valuable care such as maintenance drug use among the chronically ill. Cost-sharing should be used judiciously, with attention taken not to reduce highly cost-effective care.

show abstract

“…Without insurance, behavioral health treatment for SUD patients, which may involve treatment for drugs and/or alcohol addiction, and any comorbid mental health conditions, can be costly. 1 Despite the fact that health insurance is supposed to protect individuals from financial shocks associated with healthcare expenses, behavioral health (BH) insurance benefits, which cover MH and SUD services, have historically been less generous than insurance benefits for medical and surgical care in the employer-sponsored insurance market (Barry et al, 2003; Hodgkin, Horgan, Garnick, & Merrick, 2003; Merrick, Horgan, Garnick, & Hodgkin, 2006; Peele, Lave, & Xu, 1999). …”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Friedman

Harwood

et al. 2017

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

Background: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Methods: Claims and eligibility data from 5,987,776 enrollees, 2008–2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008–2009), during (2010), and after (2011 — 2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N = 2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Results: Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p = 0.01]; $28.33 [p = 0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p = 0.01]; 0.02 visits [p = 0.01]; 0.01 visits [p = 0.03]; 0.01 days [p = 0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p = 0.00]; $2.25/month [p = 0.00]; $0.27 [p = 0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p = 0.01]; 0.0012 days/month [p = 0.00]). Conclusion: MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization. These increases, while modest in magnitude, are larger in magnitude than increases detected among a sample of all enrollees (i.e. not only those with SUD diagnoses).

show abstract

Cost Sharing for Substance Abuse and Mental Health Services in Managed Care Plans

Cited by 15 publications

References 20 publications

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Cost-Sharing: A Blunt Instrument

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Contact Info

Product

Resources

About