1
|
Warren SE, Barron AL. Audiologists' attitudes and practice toward referring for psychosocial intervention with cochlear implant patients. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1306485. [PMID: 38239630 PMCID: PMC10794524 DOI: 10.3389/fresc.2023.1306485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024]
Abstract
Background Hearing loss is associated with a range of poor psychosocial outcomes. Cochlear implants (CI) are an available treatment option for significant hearing loss and have been linked to improved quality of life in patients. Evidence suggests that audiologists lack the skills to appropriately detect, address, and refer for psychosocial needs among patients with hearing loss. The objective of this study is to examine the attitudes and practice patterns related to psychosocial care among audiologists who work with CI users. Methods A cross-sectional survey was administered to clinical audiologists who work with CI recipients in the United States. The survey evaluated participants' attitudes toward psychosocial services and factors that contribute to their abilities to address the psychosocial needs of their patients. Additionally, participants were surveyed about their practice patterns including the use of psychosocial screeners, clinical protocols regarding psychosocial care, and referral patterns for coordinated psychosocial services. Descriptive statistics were used to summarize survey responses. Results Sixty-eight audiologists completed the survey. Of these audiologists, a majority (73.6%) held the attitude that most or all CI patients would benefit from psychosocial intervention. Despite clinicians' recognition of psychosocial needs in this population, over 90% of participants reported never screening for psychosocial symptoms. Additionally, a majority of respondents indicated that they seldom refer their patients for psychosocial services, with referrals occurring less than half the time (58%) or never (27%). Additionally, few audiologists reported utilizing protocols or resources for guiding psychosocial practices. Audiologists indicated that the primary factors that influence their psychosocial practices include time available to spend with the patient and their comfort level in counseling. Conclusion Audiologists working with CI patients recognize the potential benefit of psychosocial intervention in this population. Nevertheless, audiologists encounter barriers in clinical practice which limit their ability to identify and address the psychosocial needs of their patients. Strategies designed to enhance audiologists' capacity to recognize the psychosocial needs of CI users, in addition to improved interprofessional practice on CI teams, implies significant opportunities to improve the provision of patient-centered hearing care.
Collapse
Affiliation(s)
- Sarah E. Warren
- Department of Communication Sciences and Disorders, University of Memphis, Memphis, TN, United States
| | - Autumn L. Barron
- Department of Communication Sciences and Disorders, University of Memphis, Memphis, TN, United States
| |
Collapse
|
2
|
Harris SJ, Golberstein E, Maclean JC, Stein BD, Ettner SL, Saloner B. How policymakers innovate around behavioral health: adoption of the New Mexico "No Behavioral Health Cost-Sharing" law. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad081. [PMID: 38756394 PMCID: PMC10986291 DOI: 10.1093/haschl/qxad081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 05/18/2024]
Abstract
State policymakers have long sought to improve access to mental health and substance use disorder (MH/SUD) treatment through insurance market reforms. Examining decisions made by innovative policymakers ("policy entrepreneurs") can inform the potential scope and limits of legislative reform. Beginning in 2022, New Mexico became the first state to eliminate cost-sharing for MH/SUD treatment in private insurance plans subject to state regulation. Based on key informant interviews (n = 30), this study recounts the law's passage and intended impact. Key facilitators to the law's passage included receptive leadership, legislative champions with medical and insurance backgrounds, the use of local research evidence, advocate testimony, support from health industry figures, the severity of MH/SUD, and increased attention to MH/SUD during the COVID-19 pandemic. Findings have important implications for states considering similar laws to improve access to MH/SUD treatment.
Collapse
Affiliation(s)
- Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Ezra Golberstein
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, United States
| | | | | | - Susan L Ettner
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA 90095, United States
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, United States
| |
Collapse
|
3
|
Xie Z, Tanner R, Striley CL, Sheffield SW, Marlow NM. Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-11. [PMID: 37257284 DOI: 10.1044/2023_jslhr-22-00385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system. METHOD Using secondary data from the 2015-2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs. RESULTS The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU (OR = 0.73, 95% CI [0.60, 0.90]). CONCLUSIONS MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.
Collapse
Affiliation(s)
- Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville
| | - Rebecca Tanner
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| | | | - Sterling W Sheffield
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Nicole M Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville
| |
Collapse
|
4
|
Friedman SA, Xu H, Azocar F, Ettner SL. Quantifying Balance Billing for Out-of-Network Behavioral Health Care in Employer-Sponsored Insurance. Psychiatr Serv 2022; 73:1019-1026. [PMID: 35319917 PMCID: PMC9444804 DOI: 10.1176/appi.ps.202100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The study estimated balance billing for out-of-network behavioral health claims and described subscriber characteristics associated with higher billing. METHODS Claims data (2011-2014) from a national managed behavioral health organization's employer-sponsored insurance (N=196,034 family-years with out-of-network behavioral health claims) were used to calculate inflation-adjusted annual balance billing-the submitted amount (charged by provider) minus the allowed amount (insurer agreed to pay plus patient cost-sharing) and any discounts offered by the provider. Among family-years with complete sociodemographic data (N=68,659), regressions modeled balance billing as a function of plan and provider supply, subscriber and family-year, and employer characteristics. A two-part model accounted for family-years without balance billing. RESULTS Among the 50% of family-years with balance billing, mean±SD balance billing was $861±$3,500 (median, $175; 90th percentile, $1,684). Adjusted analysis found balance billing was higher ($523 higher, 95% confidence interval [CI]=$340, $705) for carve-out versus carve-in plans and for health maintenance organization (HMO) enrollees versus non-HMO enrollees ($156, 95% CI=$75, $237); for subscribers with a bachelor's degree, compared with an associate's degree or with a high school diploma or lower (between $172 [95% CI=$228, $116] and $224 [95% CI=$284, $163] higher, respectively); and for subscribers ages 45-54, compared with those ages 35-44 and 18-24 (between $57 [95% CI=$103, $10] and $290 [95% CI=$398, $183] higher, respectively). Balance billing was lower in states with more in-network providers per capita (-$8, 95% CI=-$10, -$5). CONCLUSIONS Balance billing for out-of-network behavioral health claims may be burdensome. Expanded behavioral health networks may improve access.
Collapse
Affiliation(s)
- Sarah A Friedman
- School of Public Health, University of Nevada, Reno (Friedman); Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (Xu, Ettner), and Department of Health Policy and Management, Fielding School of Public Health (Ettner), University of California, Los Angeles, Los Angeles; Optum, San Francisco (Azocar)
| | - Haiyong Xu
- School of Public Health, University of Nevada, Reno (Friedman); Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (Xu, Ettner), and Department of Health Policy and Management, Fielding School of Public Health (Ettner), University of California, Los Angeles, Los Angeles; Optum, San Francisco (Azocar)
| | - Francisca Azocar
- School of Public Health, University of Nevada, Reno (Friedman); Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (Xu, Ettner), and Department of Health Policy and Management, Fielding School of Public Health (Ettner), University of California, Los Angeles, Los Angeles; Optum, San Francisco (Azocar)
| | - Susan L Ettner
- School of Public Health, University of Nevada, Reno (Friedman); Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (Xu, Ettner), and Department of Health Policy and Management, Fielding School of Public Health (Ettner), University of California, Los Angeles, Los Angeles; Optum, San Francisco (Azocar)
| |
Collapse
|
5
|
Kosirnik C, Antonini Philippe R, Pomini V. Investigating the Links Between Performers' Self-Compassion, Mental Toughness and Their Social Environment: A Semi-Systematic Review. Front Psychol 2022; 13:887099. [PMID: 35910958 PMCID: PMC9331924 DOI: 10.3389/fpsyg.2022.887099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Being mentally tough while evaluating oneself in a compassionate way is still a difficult path for performers. Self-compassion, characterized by the ability to be kind to oneself, to see one's experiences as part of the larger human experience and have a balanced awareness to one's emotions and thoughts, was recently studied as a stepping stone to performance optimization and personal development. Despite a mistrust of this concept in the sports world, various studies show its benefits within athletes. A major question remains the environment that fosters or hinders the development of self-compassion: when role models extend compassionate attitudes, does it allow performers to respond in more self-compassionate ways? The relationship between self-compassion, mental toughness, and social environment is still unclear and is an important direction for future research within performers. This semi-systematic literature review aims at proposing an overview of the state of the art regarding self-compassion, mental toughness, and the influence of performer's, and social environments. Sixteen studies were retrieved. We conclude that the number of multi-day intervention programs and longitudinal studies should be increased. The studies should also consider assessing the specific aspects of performance culture and settings. In addition, overall performance-specific measures could be developed to assess general levels of self-compassion. The development of a theoretical framework explaining how self-compassion affects a performer, the role of their entourage and its link to other psychological resources, such as mental toughness, could help to better understand this concept.
Collapse
Affiliation(s)
- Celine Kosirnik
- Institute of Sports Sciences, University of Lausanne, Lausanne, Switzerland
| | | | - Valentino Pomini
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
6
|
Friedman SA, Xu H, Azocar F, Ettner SL. Comparing Gold-standard Copayment and Coinsurance Values From Claims Processing Engines to Values Derived From Behavioral Health Claims Databases. Med Care 2022; 60:279-286. [PMID: 35213427 PMCID: PMC8917070 DOI: 10.1097/mlr.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While researchers use patient expenditures in claims data to estimate insurance benefit features, little evidence exists to indicate whether the resulting measures are accurate. OBJECTIVE To develop and test an algorithm for deriving copayment and coinsurance values from behavioral health claims data. SUBJECTS Employer-sponsored insurance plans from 2011 to 2013 for a national managed behavioral health organization (MBHO). MEASURES Twelve benefit features, distinguishing between carve-in and carve-out, in-network and out-of-network, inpatient and outpatient, and copayment and coinsurance, were created. Measures drew from claims (claims-derived measures), and benefit feature data from a claims processing engine database (true measures). STUDY DESIGN We calculate sensitivity and specificity of the claims-derived measures' ability to accurately determine if a benefit feature was required and for plan-years requiring the benefit feature, the accuracy of the claims-derived measures. Accuracy rates using the minimum, 25th, 50th, 75th, and maximum claims value for a plan-year were compared. PRINCIPAL FINDINGS Sensitivity (82% or higher for all but 3 benefit features) and specificity (95% or higher for all but 2 benefit features) were relatively high. Accuracy rates were highest using the 75th or maximum claims value, depending on the benefit feature, and ranged from 69% to 99% for all benefit features except for out-of-network inpatient coinsurance. CONCLUSIONS For most plan-years, claims-derived measures correctly identify required specialty mental health copayments and coinsurance, although the claims-derived measures' accuracy varies across benefit design features. This information should be considered when creating claims-derived benefit features to use for policy analysis.
Collapse
Affiliation(s)
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | | | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
7
|
Charlesworth CJ, Zhu JM, Horvitz-Lennon M, McConnell KJ. Use of behavioral health care in Medicaid managed care carve-out versus carve-in arrangements. Health Serv Res 2021; 56:805-816. [PMID: 34312839 DOI: 10.1111/1475-6773.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate differences in access to behavioral health services for Medicaid enrollees covered by a Medicaid entity that integrated the financing of behavioral and physical health care ("carve-in group") versus a Medicaid entity that separated this financing ("carve-out group"). DATA SOURCES/STUDY SETTING Medicaid claims data from two Medicaid entities in the Portland, Oregon tri-county area in 2016. STUDY DESIGN In this cross-sectional study, we compared differences across enrollees in the carve-in versus carve-out group, using a machine learning approach to incorporate a large set of covariates and minimize potential selection bias. Our primary outcomes included behavioral health visits for a variety of different provider types. Secondary outcomes included inpatient, emergency department, and primary care visits. DATA COLLECTION We used Medicaid claims, including adults with at least 9 months of enrollment. PRINCIPAL FINDINGS The study population included 45,786 adults with mental health conditions. Relative to the carve-out group, individuals in the carve-in group were more likely to access outpatient behavioral health (2.39 percentage points, p < 0.0001, with a baseline rate of approximately 73%). The carve-in group was also more likely to access primary care physicians, psychologists, and social workers and less likely to access psychiatrists and behavioral health specialists. Access to outpatient behavioral health visits was more likely in the carve-in arrangement among individuals with mild or moderate mental health conditions (compared to individuals with severe mental illness) and among black enrollees (compared to white enrollees). CONCLUSIONS Financial integration of physical and behavioral health in Medicaid managed care was associated with greater access to behavioral health services, particularly for individuals with mild or moderate mental health conditions and for black enrollees. Recent changes to incentivize financial integration should be monitored to assess differential impacts by illness severity, race and ethnicity, provider types, and other factors.
Collapse
Affiliation(s)
- Christina J Charlesworth
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, Cambridge Heath Alliance and Harvard Medical School, Boston, Massachusetts, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
8
|
Hamersma S, Maclean JC. Insurance expansions and adolescent use of substance use disorder treatment. Health Serv Res 2021; 56:256-267. [PMID: 33210305 PMCID: PMC7969204 DOI: 10.1111/1475-6773.13604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To provide evidence on the effects of expansions to private and public insurance programs on adolescent specialty substance use disorder (SUD) treatment use. DATA SOURCE/STUDY SETTING The Treatment Episodes Data Set (TEDS), 1996 to 2017. STUDY DESIGN A quasi-experimental difference-in-differences design using observational data. DATA COLLECTION The TEDS provides administrative data on admissions to specialty SUD treatment. PRINCIPAL FINDINGS Expansions of laws that compel private insurers to cover SUD treatment services at parity with general health care increase adolescent admissions by 26% (P < .05). These increases are driven by nonintensive outpatient admissions, the most common treatment episodes, which rise by 30% (P < .05) postparity law. In contrast, increases in income eligibility for public insurance targeting those 6-18 years old are not statistically associated with SUD treatment. CONCLUSIONS Private insurance expansions allow more adolescents to receive SUD treatment, while public insurance income eligibility expansions do not appear to influence adolescent SUD treatment.
Collapse
Affiliation(s)
- Sarah Hamersma
- Department of Public Administration and International AffairsSyracuse UniversitySyracuseNew YorkUSA
- Center for Policy ResearchSyracuseNew YorkUSA
| | - Johanna Catherine Maclean
- Department of EconomicsTemple UniversityPhiladelphiaPennsylvaniaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
- Institute for the Study of LaborBonnGermany
| |
Collapse
|
9
|
Block EP, Xu H, Azocar F, Ettner SL. The Mental Health Parity and Addiction Equity Act evaluation study: Child and adolescent behavioral health service expenditures and utilization. HEALTH ECONOMICS 2020; 29:1533-1548. [PMID: 32813304 DOI: 10.1002/hec.4153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 06/11/2023]
Abstract
This study explores possible associations of the Mental Health Parity and Addiction Equity Act (MHPAEA) with child access to behavioral health (BH) services (preimplementation = 2008-2009, transition = 2010, and post = 2011-2013). The study sample included children aged 4-17 years in self-insured "carve-in" plans from large employers. In "carve-ins," BH and medical care are covered through the same insurance plan. The unit of analysis is the person-month (N = 61,823,533). This study employs an interrupted time series model allowing for intercept and slope changes for the transition and postparity periods. Outcomes included total, plan and patient out-of-pocket (OOP) expenditures, and several categories of service utilization. Generalized estimating equations were used to account for clustering. There were significant increases in total and plan expenditures postparity. To illustrate, in July 2012, mean per-member-per-month total expenditures were predicted to be $5.65 without parity but $8.72 with parity. Patient OOP costs did not change significantly. Significant overall increases were seen for utilization of most outpatient services but not intermediate or inpatient services. Our findings suggest that the introduction of MHPAEA was associated with an increase in specialty BH service access for children without a commensurate increase in financial burden for families.
Collapse
Affiliation(s)
- Eryn Piper Block
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Susan L Ettner
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
10
|
Friedman S, Xu H, Azocar F, Ettner SL. Carve-out plan financial requirements associated with national behavioral health parity. Health Serv Res 2020; 55:924-931. [PMID: 32880927 DOI: 10.1111/1475-6773.13542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine changes in carve-out financial requirements (copayments, coinsurance, use of deductibles, and out-of-pocket maxima) following the Mental Health Parity and Addiction Equity Act (MHPAEA). DATA SOURCE/STUDY SETTING Specialty mental health benefit design information for employer-sponsored carve-out plans from a national managed behavioral health organization's claims processing engine (2008-2013). STUDY DESIGN This pre-post study reports linear and logistic regression as the main analysis. DATA COLLECTION/EXTRACTION METHODS NA. PRINCIPAL FINDINGS Copayments for in-network emergency room (-$44.9, 95% CI: -78.3, -11.5; preparity mean: $56.2), outpatient services (eg, individual psychotherapy: -$7.4, 95% CI: -10.5, -4.2; preparity mean: $17.8), and out-of-network coinsurance for emergency room (-11 percentage points, 95% CI: -16.7, -5.4; preparity mean: 38.8 percent) and outpatient (eg, individual psychotherapy: -5.8 percentage points, 95% CI: -10.0, -1.6; preparity mean 41.0 percent) decreased. Probability of family OOP maxima use (29 percentage points, 95% CI: 19.3, 38.6; preparity mean: 36 percent) increased. In-network outpatient coinsurance increased (eg, individual psychotherapy: 4.5 percentage points, 95% CI: 1.1, 7.9; preparity mean: 2.7 percent), as did probability of use of family deductibles (15 percentage points, 95% CI: 6.1, 23.3; preparity mean: 38 percent). CONCLUSIONS MHPAEA was associated with increased generosity in most financial requirements observed here. However, increased use of deductibles may have reduced generosity for some patients.
Collapse
Affiliation(s)
- Sarah Friedman
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
11
|
The Role of Psychiatry in Treating Burnout Among Nurses During the Covid-19 Pandemic. JOURNAL OF RADIOLOGY NURSING 2020; 39:176-178. [PMID: 32837392 PMCID: PMC7377731 DOI: 10.1016/j.jradnu.2020.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The prevalence of burnout among US registered nurses ranges from 35 to 45%. In one study, nurses had twice the rate of depression compared with other health care professionals. Owing to the Covid-19 pandemic, burnout is a major threat to the stability of the workforce on the front lines. Consultation-liaison (C/L) psychiatry can provide assistance through liaison meetings, stress management programs, and curbside consults to help reduce the risk of burnout. Narrative medicine programs, mindfulness-based stress reduction, and meditation apps are additional means to alleviate stress. Given the current challenges facing C/L psychiatry and the mental health field in general, there is an urgent need to overcome stigma and financial barriers to make treatment readily accessible.
Collapse
|
12
|
Benson NM, Song Z. Prices And Cost Sharing For Psychotherapy In Network Versus Out Of Network In The United States. Health Aff (Millwood) 2020; 39:1210-1218. [PMID: 32634359 DOI: 10.1377/hlthaff.2019.01468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients in the US are more likely to receive out-of-network behavioral health care, including treatment for mental health or substance use disorders, than they are to receive other medical and surgical services out of network. To date, out-of-network and in-network trends in the prices and use of ambulatory behavioral health care have been seldom described. Here we compare levels and growth of insurer-negotiated prices (allowed amounts), patient cost sharing, and use of psychotherapy services in network and out of network in a large, commercially insured US population during 2007-17. For both adult and child psychotherapy, prices and cost sharing were substantially higher out of network than they were in network. These gaps widened during the eleven-year period. Prices and cost sharing for in-network psychotherapy decreased during this period, whereas prices and cost sharing for out-of-network psychotherapy increased. Use of adult and child psychotherapy increased during this period, driven by growth of in-network rather than out-of-network use. The increasing gap in prices and cost sharing between out-of-network and in-network psychotherapy, viewed in the context of a shortage of behavioral health providers who accept insurance, may limit access to ambulatory behavioral health care.
Collapse
Affiliation(s)
- Nicole M Benson
- Nicole M. Benson is an instructor in psychiatry at Harvard Medical School, in Boston, Massachusetts, and a psychiatrist at Massachusetts General Hospital and McLean Hospital, in Belmont, Massachusetts
| | - Zirui Song
- Zirui Song is an assistant professor of health care policy and medicine at Harvard Medical School, a general internist at Massachusetts General Hospital, and faculty member in the Center for Primary Care at Harvard Medical School
| |
Collapse
|
13
|
Zhong Y, Wu X. Effects of cost-benefit analysis under back propagation neural network on financial benefit evaluation of investment projects. PLoS One 2020; 15:e0229739. [PMID: 32134951 PMCID: PMC7058345 DOI: 10.1371/journal.pone.0229739] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
To determine the influence of the weight of the economic effectiveness evaluation criteria of the major investments of listed enterprises, and provide new management ideas for the development of the follow-up enterprises, firstly, the financial benefit evaluation system of investment projects is analyzed and constructed, and the specific evaluation process is analyzed. Then, on this basis, the evaluation index is refined; the basic structure of BP neural network (BPNN) is introduced, and genetic algorithm is used to improve BP neural network. The cost-benefit analysis model is constructed based on the improved BPNN. The listed company A is taken as an example to analyze its development data in recent years, and then the data of 10 listed companies are taken as the research object. Matlab simulation software is used to train and verify the improved BPNN model, analyze and predict the weight value of the financial benefit index of the investment projects of these 10 companies, and then determine the index to improve the financial benefit of the investment projects. Under the analysis of the development data of listed company A in the past 10 years, it is found that the indicators of the listed company's profitability per share, debt risk operation ability, development, and growth ability in the past 10 years are in relatively stable state. The principal component analysis of its 20 secondary sub-indexes is conducted based on the four primary indicators: profitability, debt risk, operational capacity, and development and growth. A total of eight principal components including return on equity (ROE), return on assets (ROA), (total asset turnover) TATO, turnover of account receivable (AR), asset-liability ratio, interest protection multiple, income growth rate, and year-on-year rate of increase for complete assets are extracted. The average error between the final output value, the actual value, and the expected value is 0.0304 and 0.0169, respectively. The weight coefficient of the monetary benefits evaluation indicator of investment items is calculated, and the computed results show that year-on-year rate of increase for complete assets, TOTA, ROA, turnover of total capital, and ROE are important indexes in the financial benefit evaluation of investment projects. It indicates that to improve the financial benefit of investment projects of listed enterprises, it is necessary to enhance the year-over-year growth degree of total properties and ROA.
Collapse
Affiliation(s)
- Youwen Zhong
- School of Economics and Finance, Xi’an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoling Wu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
14
|
Grecco GG, Andrew Chambers R. The Penrose Effect and its acceleration by the war on drugs: a crisis of untranslated neuroscience and untreated addiction and mental illness. Transl Psychiatry 2019; 9:320. [PMID: 31780638 PMCID: PMC6882902 DOI: 10.1038/s41398-019-0661-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
In 1939, British psychiatrist Lionel Penrose described an inverse relationship between mental health treatment infrastructure and criminal incarcerations. This relationship, later termed the 'Penrose Effect', has proven remarkably predictive of modern trends which have manifested as reciprocal components, referred to as 'deinstitutionalization' and 'mass incarceration'. In this review, we consider how a third dynamic-the criminalization of addiction via the 'War on Drugs', although unanticipated by Penrose, has likely amplified the Penrose Effect over the last 30 years, with devastating social, economic, and healthcare consequences. We discuss how synergy been the Penrose Effect and the War on Drugs has been mediated by, and reflects, a fundamental neurobiological connection between the brain diseases of mental illness and addiction. This neuroscience of dual diagnosis, also not anticipated by Penrose, is still not being adequately translated into improving clinical training, practice, or research, to treat patients across the mental illness-addictions comorbidity spectrum. This failure in translation, and the ongoing fragmentation and collapse of behavioral healthcare, has worsened the epidemic of untreated mental illness and addictions, while driving unsustainable government investment into mass incarceration and high-cost medical care that profits too exclusively on injuries and multi-organ diseases resulting from untreated addictions. Reversing the fragmentation and decline of behavioral healthcare with decisive action to co-integrate mental health and addiction training, care, and research-may be key to ending criminalization of mental illness and addiction, and refocusing the healthcare system on keeping the population healthy at the lowest possible cost.
Collapse
Affiliation(s)
- Gregory G Grecco
- Medical Scientist Training Program, Indiana University of School of Medicine, Indianapolis, IN, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
- Laboratory for Translational Neuroscience of Dual Diagnosis & Development, IU Neuroscience Research Center, Indianapolis, IN, USA.
| |
Collapse
|
15
|
Mulia N, Lui CK, Ye Y, Subbaraman MS, Kerr WC, Greenfield TK. U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference? J Subst Abuse Treat 2019; 106:113-121. [PMID: 31451310 DOI: 10.1016/j.jsat.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/11/2019] [Accepted: 08/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. METHODS We analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. RESULTS While we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. CONCLUSION The MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.
Collapse
Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Meenakshi S Subbaraman
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| |
Collapse
|
16
|
Mulvaney-Day N, Gibbons BJ, Alikhan S, Karakus M. Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. Am J Public Health 2019; 109:S190-S196. [PMID: 31242013 DOI: 10.2105/ajph.2019.305023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess the impact of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) on mental and substance use disorder services in the private, large group employer-sponsored insurance market in the United States. Methods. We analyzed data from the IBM MarketScan Commercial Database from January 2005 through September 2015 by using population-level interrupted time series regressions to determine whether parity implementation was associated with utilization and spending outcomes. Results. MHPAEA had significant positive associations with utilization of mental and substance use disorder outpatient services. A spending decomposition analysis indicated that increases in utilization were the primary drivers of increases in spending associated with MHPAEA. Analyses of opioid use disorder and nonopioid substance use disorder services found that associations with utilization and spending were not attributable only to increases in treatment of opioid use disorder. Conclusions. MHPAEA is positively associated with utilization of outpatient mental and substance use disorder services for Americans covered by large group employer-sponsored insurance. Public Health Implications. These trends continued over the 5-year post-MHPAEA period, underscoring the long-term relationship between this policy change and utilization of behavioral health services.
Collapse
Affiliation(s)
- Norah Mulvaney-Day
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Brent J Gibbons
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Shums Alikhan
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| | - Mustafa Karakus
- Norah Mulvaney-Day and Mustafa Karakus are with Behavioral Health Research and Policy, Government Health and Human Services, IBM Watson Health, Cambridge, MA. Brent J. Gibbons is with the Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore. At the time of the study, Shums Alikhan was with Government Health and Human Services, IBM Watson Health
| |
Collapse
|
17
|
Li X, Ma J. Does Mental Health Parity Encourage Mental Health Utilization Among Children and Adolescents? Evidence from the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). J Behav Health Serv Res 2019; 47:38-53. [DOI: 10.1007/s11414-019-09660-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
18
|
Haffajee RL, Mello MM, Zhang F, Busch AB, Zaslavsky AM, Wharam JF. Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services. Med Care 2019; 57:245-255. [PMID: 30807450 PMCID: PMC6423539 DOI: 10.1097/mlr.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act. OBJECTIVES To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers. RESEARCH DESIGN Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group. SUBJECTS Commercially insured enrollees aged 18-64 with a mental health disorder drawn from 24 states where self-insured employers were newly subject to federal parity in 2010 (exposure group), but small employers were exempt before-and-after parity (comparison group). A total of 11,226 exposure group members were propensity score matched (1:1) to comparison group members, all of whom were continuously enrolled from 1 year prepolicy to 1-2 years postpolicy. MEASURES Mental health outpatient visits, out-of-pocket spending for these visits, emergency department visits, and hospitalizations. RESULTS Relative to comparison group members, mean out-of-pocket spending per outpatient mental health visit declined among exposure enrollees by $0.74 (1.40, 0.07) and $2.03 (3.17, 0.89) in years 1 and 2 after the policy, respectively. Corresponding annual mental health visits increased by 0.31 (0.12, 0.51) and 0.59 (0.37, 0.81) per enrollee. Difference-in-difference changes were larger for the highest baseline quartile mental health care utilizers [year 2: 0.76 visits per enrollee (0.14, 1.38); relative increase 10.07%] and spenders [year 2: $-2.28 (-3.76, -0.79); relative reduction 5.91%]. There were no significant difference-in-differences changes in emergency department visits or hospitalizations. CONCLUSIONS In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity.
Collapse
Affiliation(s)
- Rebecca L Haffajee
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michelle M Mello
- Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Alisa B Busch
- McLean Hospital, Belmont
- Departments of Psychiatry
- Health Care Policy, Harvard Medical School, Boston, MA
| | | | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| |
Collapse
|
19
|
Drake C, Busch SH, Golberstein E. The Effects of Federal Parity on Mental Health Services Use and Spending: Evidence From the Medical Expenditure Panel Survey. Psychiatr Serv 2019; 70:287-293. [PMID: 30691381 DOI: 10.1176/appi.ps.201800313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the effects of the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 on the use of outpatient and clinic-based mental health services and spending on those services. METHODS Data came from the 2005-2013 Medical Expenditure Panel Survey. The analytic sample included adults ages 26-64 who were continuously enrolled in employer-sponsored insurance for a calendar year (N=66,602 person-year observations). A difference-in-differences study design was used to compare changes in outcomes before and after implementation of the MHPAEA between people whose insurance plan was or was not affected by the law. RESULTS The federal parity law was not significantly associated with changes in the likelihood of using mental health services, the amount of mental health services used, or total or out of-pocket spending for mental health services. The law was marginally significantly associated with a shift toward more use of mental health specialty services rather than primary care services among individuals who used ambulatory mental health care. CONCLUSIONS Consistent with other research using different study designs and data, this study found that the MHPAEA had at most small effects on patterns of mental health services use and spending through 2013. Understanding whether these effects were small because most employer-sponsored plans were already parity compliant or because plans were noncompliant with the law has major implications for mental health policy and parity enforcement.
Collapse
Affiliation(s)
- Coleman Drake
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
| | - Susan H Busch
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
| | - Ezra Golberstein
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh (Drake); Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Busch); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein)
| |
Collapse
|
20
|
Friedman SA, Azocar F, Xu H, Ettner SL. 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? Drug Alcohol Depend 2018; 190:151-158. [PMID: 30032052 PMCID: PMC6197987 DOI: 10.1016/j.drugalcdep.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/11/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022]
Abstract
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 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.
Collapse
Affiliation(s)
- Sarah A. Friedman
- Department of Health Policy and Management, Fielding School of Public Health, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 S. Broxton Avenue, Los Angeles, CA 90095, United States, , Phone: 775-784-1816
| | - Francisca Azocar
- Optum, United Health Group, 245 Market Street, San Francisco, 94105, United States, , Phone: 415-547-6148
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 S. Broxton Avenue, Los Angeles, CA 90095, United States,
| | - Susan L. Ettner
- Department of Health Policy and Management, Fielding School of Public Health, and Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 S. Broxton Avenue, Los Angeles, CA 90095, United States, , Phone: 310-794-2289
| |
Collapse
|
21
|
Cowell AJ, Prakash S, Jones E, Barnosky A, Wedehase B. Behavioral Health Coverage In The Individual Market Increased After ACA Parity Requirements. Health Aff (Millwood) 2018; 37:1153-1159. [PMID: 29985686 DOI: 10.1377/hlthaff.2017.1517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits. The results suggest that plan issuers did what the provisions required them to do. Although in 2013 a lower proportion of plans covered mental health or substance use care, compared to medical/surgical care, in 2014 the proportions were the same. If essential health benefit requirements were to be removed and mental health and substance use coverage becomes similar to that in 2013, as many as 20 percent of the plans in our sample would not cover these conditions. To determine whether increases in behavioral health coverage will result in improved access to behavioral health services requires complementary data on the size of provider networks and use of services.
Collapse
Affiliation(s)
- Alexander J Cowell
- Alexander J. Cowell ( ) is a senior research economist at RTI International in Research Triangle Park, North Carolina
| | - Shivaani Prakash
- Shivaani Prakash is a public health research analyst at RTI International in San Francisco, California
| | - Emily Jones
- Emily Jones is a professorial lecturer in the Department of Health Policy and Management, George Washington University, in Washington, D.C
| | - Alan Barnosky
- Alan Barnosky is an economist at RTI International in Research Triangle Park
| | - Brendan Wedehase
- Brendan Wedehase is an economist at RTI International in Research Triangle Park
| |
Collapse
|
22
|
Thalmayer AG, Harwood JM, Friedman S, Azocar F, Watson LA, Xu H, Ettner SL. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Nonquantitative Treatment Limits for Specialty Behavioral Health Care. Health Serv Res 2018; 53:4584-4608. [PMID: 29740807 DOI: 10.1111/1475-6773.12871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess frequency, type, and extent of behavioral health (BH) nonquantitative treatment limits (NQTLs) before and after implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). DATA SOURCES Secondary administrative data for Optum carve-out and carve-in plans. STUDY DESIGN Cross-tabulations and "two-part" regression models were estimated to assess associations of parity period with NQTLs. DATA COLLECTION/EXTRACTION METHODS Optum provided four proprietary BH databases, including 2008-2013 data for 40 carve-out and 385 carve-in employers from Optum's claims processing databases and 2010 data from interviews conducted by Optum's parity compliance team with 49 carve-out employers. PRINCIPAL FINDINGS Preparity, carve-out plans required preauthorization for in-network inpatient/intermediate care; otherwise coverage was denied. Postparity, 73 percent would review later by request and half charged no penalty for late authorization. Outpatient visit authorization requirements virtually disappeared. For carve-out out-of-network inpatient/intermediate care, and for carve-ins, plans changed penalties to match medical service policies, but this did not necessarily lead to fewer requirements or lower penalties. CONCLUSION After 2011, MHPAEA was associated with the transformation of BH care management, including much less restrictive preauthorization requirements, especially for in-network care provided by carve-out plans.
Collapse
Affiliation(s)
| | - Jessica M Harwood
- Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA
| | - Sarah Friedman
- Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, NV
| | | | | | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
23
|
Hodgkin D, Horgan CM, Stewart MT, Quinn AE, Creedon TB, Reif S, Garnick DW. Federal Parity and Access to Behavioral Health Care in Private Health Plans. Psychiatr Serv 2018; 69:396-402. [PMID: 29334882 PMCID: PMC8508592 DOI: 10.1176/appi.ps.201700203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. METHODS A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student's t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care. RESULTS In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014. CONCLUSIONS Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.
Collapse
Affiliation(s)
- Dominic Hodgkin
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Constance M Horgan
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maureen T Stewart
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amity E Quinn
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Timothy B Creedon
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Reif
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah W Garnick
- Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Purtle J, Borchers B, Clement T, Mauri A. Inter-Agency Strategies Used by State Mental Health Agencies to Assist with Federal Behavioral Health Parity Implementation. J Behav Health Serv Res 2017; 45:516-526. [PMID: 29247374 DOI: 10.1007/s11414-017-9581-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Benjamin Borchers
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, 3215 Market St., Philadelphia, PA, 19104, USA
| | | | | |
Collapse
|
25
|
Friedman S, Xu H, Harwood JM, Azocar F, Hurley B, Ettner SL. The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders. J Subst Abuse Treat 2017; 80:67-78. [PMID: 28755776 DOI: 10.1016/j.jsat.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022]
Abstract
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]; 0.01days [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]; 0.0012days/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).
Collapse
Affiliation(s)
- Sarah Friedman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024, United States; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA 90024, United States; School of Community Health Sciences, Division of Health Sciences, University of Nevada, 1664 N. Virginia Street, Reno, NV 89557, United States.
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA 90024, United States.
| | - Jessica M Harwood
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90024, United States.
| | - Francisca Azocar
- Optum®, United Health Group, 425 Market Street, 14th Floor, San Francisco, CA 94105, United States.
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 50-078 Center for Health Sciences, Box 951683, Los Angeles, CA 90095, United States.
| | - Susan L Ettner
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024, United States; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA 90024, United States.
| |
Collapse
|