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

Ettner, Susan L.; Harwood, Jessica M.; Thalmayer, Amber Gayle; Ong, Michael; Xu, Hongquan; Bresolin, Michael J.; Wells, Kenneth B.; Tseng, Chi‐Hong; Azocar, Francisca

doi:10.1016/j.jhealeco.2016.09.009

Cited by 47 publications

(47 citation statements)

References 21 publications

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“…In much of the literature, implementation of parity has been associated with improved financial protection for individuals with mental health conditions. 9,12,15,16,18,28,29 Our finding of a reduction in OOP mental health spending attributable to parity among all children with mental health conditions is consistent with the limited body of literature focused on children. 28,29 Although the estimated reduction in OOP spending was larger in magnitude for children with high spending than among children with mental health conditions more broadly (−$234 vs −$140), given the much higher average annual OOP spending preparity among the high spending group ($1439 among children enrolled in plans subject to parity), this constitutes a relatively small reduction in OOP spending attributable to the law.…”

Section: Discussionsupporting

confidence: 85%

Federal Parity and Spending for Mental Illness

et al. 2018

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BACKGROUND: Families of children with mental health conditions face heavy economic burdens. One of the objectives of the Mental Health Parity and Addiction Equity Act (MHPAEA) is to reduce the financial burden for those with intensive mental health service needs. Few researchers to date have examined MHPAEA’s effects on children with mental health conditions and those with particularly high mental health expenditures. METHODS: A difference-in-differences approach was used to compare commercially insured children ages 3 to 18 years (in 2008) who were continuously enrolled in plans newly subject to parity under MHPAEA to children continuously enrolled in plans never subject to parity. Data included inpatient, outpatient, and pharmaceutical claims for 2008–2012 from 3 national commercial insurers. We examined annual mental health service use and spending outcomes. RESULTS: Among children with mental health conditions who were enrolled in plans subject to parity, parity was associated with $140 (95% confidence interval: −$196 to −$84) lower average annual out-of-pocket (OOP) mental health spending than expected given changes in the comparison group. Among children who were ≥85th percentile in total mental health spending, parity was associated with $234 (−$391 to −$76) lower average annual OOP mental health spending. CONCLUSIONS: MHPAEA was associated with increased financial protection on average for children with mental health conditions and among those at the higher end of the spending distribution. However, estimated reductions in OOP spending were likely too modest to have substantially reduced financial burden on families of children with particularly high mental health expenditures.

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Section: Discussionsupporting

confidence: 85%

Federal Parity and Spending for Mental Illness

et al. 2018

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“…In turn, MBHOs administer behavioral benefits on behalf of twothirds of insured patients. 23 Given the consistent pattern that members of racial/ethnic minority groups are less likely to receive services but (after adjusting for SES) have similar patterns of care intensity once they have entered treatment, our results suggest that racial/ethnic differences in behavioral health care utilization in our cohort may not be primarily driven by provider bias. Barriers more likely to play a significant role in these differences are those that might inhibit individuals from seeking care to begin with, including perceived need, perceived stigma, provider mistrust, and lack of cultural competence of primary care providers (which may lead to an underdiagnosis of behavioral health care conditions and limit referrals to specialty behavioral health care providers).…”

Section: Discussionmentioning

confidence: 56%

“…As Optum was the largest MBHO in the nation during our study period, we believe that Optum enrollees are representative of the MBHO population overall. In turn, MBHOs administer behavioral benefits on behalf of two‐thirds of insured patients …”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans

Narain

Azocar

et al. 2019

Health Services Research

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Objective To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES). Data Source The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013. Study Design We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls. Data Collection This study links administrative data from a managed BH organization to a commercial marketing database. Principal Findings We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non‐English speakers, Asian English speakers, Hispanic non‐English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration. Conclusions In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.

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“…In addition to addressing historical inequities between medical/surgical and specialty mental health (MH) benefits, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was the first national parity law to require parity for substance use disorder (SUD) benefits (Ettner et al, 2016). This landmark piece of legislation required commercial large-group insurance plans covering behavioral health (BH, i.e.…”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

Friedman

Azocar

et al. 2018

Drug and Alcohol Dependence

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Background: To assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e. copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services. Methods: MH and SUD copayments and coinsurance, 2008–2013, were obtained from benefits databases for “carve-in” and “carve-out” plans from Optum®. Linear regression was used to estimate the association of MHPAEA with differences between specialty MH and SUD care financial requirements among “carve-in” and “carve-out” plans. A two-part regression model investigated whether MHPAEA was associated with changes in the use or level of financial requirements for SUD-specific services among “carve-out” plans. Results: MHPAEA was not associated with significant changes in the difference between SUD and MH copayments or coinsurance levels among either “carve-in” or “carve-out” plans. MHPAEA was associated with decreases in the levels of inpatient (in-network: −$51.17; out-of-network: −$34.39) and outpatient (in-network: −$10.26) detox copayments, but increases in the levels of in-network outpatient detox coinsurance (6 percentage points) among all “carve-out” plans. Conclusion: Even if SUD benefits had been historically less generous than MH benefits, SUD financial requirements were already at parity with MH financial requirements by the time MHPAEA was passed, among Optum® plans. MHPAEA’s SUD parity mandate reduced cost-sharing for detox services via copayments, but, for outpatient detox, the law simultaneously increased cost-sharing via coinsurance.

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

Cited by 47 publications

References 21 publications

Federal Parity and Spending for Mental Illness

Federal Parity and Spending for Mental Illness

Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

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