Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer

Grazier, Kyle L.; Eisenberg, Daniel; Jedele, Jenefer; Smiley, Mary L.

doi:10.1176/appi.ps.201400586

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…regarding outpatient MI utilization. 17 Our result of increased per-user inpatient BH utilization suggests a roughly similar story to that of McGinty et al, though via a different mechanism: the latter study found increases in the probability of any inpatient OON SUD service use among users of SUD services, 16 and our study found increases in the number of days of inpatient treatment among users of inpatient care. To our knowledge there are no peer-reviewed studies reporting significant changes to plan spending or intermediate care use.…”

Section: Discussionsupporting

confidence: 84%

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The Mental Health Parity and Addiction Equity Act Evaluation Study

et al. 2017

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Objective The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA’s impact on BH expenditures and utilization among “carve-in” enrollees. Method We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008–2009), during (2010), and after (2011–2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual and family psychotherapy); intermediate care utilization (structured outpatient; day treatment; residential); and inpatient utilization. Results MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits (respective immediate increases of: $1.05 [p=0.02]; $0.88 [p=0.04]; 0.00045 visits [p=0.00]), and individual psychotherapy visits (immediate increase of 0.00578 visits [p=0.00] and additional increases of 0.00017 visits/month [p=0.03]). Conclusions MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; e.g., in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

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Section: Discussionsupporting

confidence: 84%

“…16 Grazier et al found an association between MHPAEA and increases in outpatient mental health service use among high utilizers, but only studied data from one employer, and only considered changes between 2009 and 2010. 17 …”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act Evaluation Study

et al. 2017

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“…These trends may be related to enhanced mental health coverage in recent years after parity legislation, which may also explain greater continuity in treatment in more recent years. 42 However, these findings need to be corroborated in future studies, especially with regard to increased inpatient treatment that was most prominent in 2014.…”

Section: Discussionmentioning

confidence: 95%

National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults

2016

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RESULTS:The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.

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“…Among the general population, there is some evidence of modest utilization increases associated with MHPAEA. Examining the effects of MHPAEA among high-utilizers at one employer group, Grazier et al found an association between MHPAEA and increases in outpatient mental health service use (Grazier, Eisenberg, Jedele, & Smiley, 2015). Two additional studies documented modest increases in expenditures and utilization among all patients enrolled in carve-in plans, which administer both BH and medical benefits (Harwood et al, 2017) and carve-out plans, those that administer only BH benefits (Ettner et al, 2016).…”

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

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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).

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Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer

Abstract: Federal mental health parity legislation is likely to increase utilization of mental health services by individuals who had previously met their benefit limit.

Cited by 9 publications

References 12 publications

The Mental Health Parity and Addiction Equity Act Evaluation Study

The Mental Health Parity and Addiction Equity Act Evaluation Study

National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults

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

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