1
|
Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M. Private health insurance coverage of drug use disorder treatment: 2005-2018. PLoS One 2020; 15:e0240298. [PMID: 33035265 PMCID: PMC7546457 DOI: 10.1371/journal.pone.0240298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022] Open
Abstract
Many privately insured adults with drug use disorders in the United States do not have health care coverage for drug use treatment. The Affordable Care Act sought to redress this gap by including substance use treatments as essential health benefits under new plans offered. This study used data from 11,732 privately insured adult participants of the 2005-2018 National Survey on Drug Use and Health with drug use disorders to examine trends in drug use treatment coverage and the association of coverage with receiving treatment. 37.6% of the participants with drug use disorders did not know whether their plan covered drug use treatment, with little change over time. Among those who knew, coverage increased modestly between the 2005-2013 and 2014-2018 periods (73.5% vs. 77.5%, respectively, p = .015). Coverage was associated with receiving drug use treatment (adjusted odds ratio = 2.09, 95% confidence interval = 1.61-2.72, p < .001). However, even among participants with coverage, only 13.4% received treatment. Broader coverage of drug use treatment could potentially improve treatment rates.
Collapse
Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States of America
| | - Christine Mauro
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Melanie M. Wall
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Colleen L. Barry
- Department of Health Policy and Management and Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| |
Collapse
|
2
|
Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity. Med Care 2020; 58:101-107. [PMID: 31688556 DOI: 10.1097/mlr.0000000000001242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. OBJECTIVES To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). RESEARCH DESIGN Observational study using an interrupted time series design. SUBJECTS 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics. MEASURES Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance. RESULTS Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs. CONCLUSIONS After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.
Collapse
|
3
|
Downey LVA, Hong A, Herrera K. Changes in Proportions of Emergency Department Patients with Mental Illness Noted in the National Hospital Ambulatory Medical Care Survey, 2012–2015. South Med J 2020; 113:51-54. [DOI: 10.14423/smj.0000000000001064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
4
|
PURTLE JONATHAN, LÊ‐SCHERBAN FÉLICE, WANG XI, SHATTUCK PAULT, PROCTOR ENOLAK, BROWNSON ROSSC. State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels. Milbank Q 2019; 97:1200-1232. [PMID: 31710152 PMCID: PMC6904266 DOI: 10.1111/1468-0009.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators' opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators' stigma toward people with mental illness could increase their support for state behavioral health parity laws CONTEXT: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators' fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators' fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support. METHODS We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. FINDINGS Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. CONCLUSIONS Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.
Collapse
Affiliation(s)
| | | | - XI WANG
- PolicyLab, Children's Hospital of Philadelphia
| | - PAUL T. SHATTUCK
- Dornsife School of Public HealthDrexel University
- A.J. Drexel Autism InstituteDrexel University
| | - ENOLA K. PROCTOR
- Center for Mental Health Services ResearchBrown School at Washington University in St. Louis
| | - ROSS C. BROWNSON
- Prevention Research Center in St. LouisBrown at Washington University in St. Louis
- Division of Public Health Sciences and Alvin J. Siteman Cancer CenterWashington University School of Medicine, Washington University in St. Louis
| |
Collapse
|
5
|
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
|
6
|
Travers JL, Le C, Desai MM, Merrill JA. Factors Associated with Dissatisfaction in Medical Care Quality among Older Medicare Beneficiaries Suffering from Mental Illness. J Aging Soc Policy 2019; 33:51-66. [DOI: 10.1080/08959420.2019.1628624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jasmine L. Travers
- Postdoctoral Fellow, National Clinician Scholars Program, Yale Schools of Medicine and Nursing, New Haven, Connecticut, USA
| | - Cindy Le
- MPH Candidate, Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Mayur M. Desai
- Associate Professor of Epidemiology, Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jacqueline A. Merrill
- Professor of Nursing,Department of Biomedical Informatics at Columbia University Medical Center, Columbia University School of Nursing, New York, New York, USA
| |
Collapse
|
7
|
Andrews CM, Grogan CM, Smith BT, Abraham AJ, Pollack HA, Humphreys K, Westlake MA, Friedmann PD. Medicaid Benefits For Addiction Treatment Expanded After Implementation Of The Affordable Care Act. Health Aff (Millwood) 2019; 37:1216-1222. [PMID: 30080460 DOI: 10.1377/hlthaff.2018.0272] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) established a minimum standard of insurance benefits for addiction treatment and expanded federal parity regulations to selected Medicaid benefit plans, which required state Medicaid programs to make changes to their addiction treatment benefits. We surveyed Medicaid programs in all fifty states and the District of Columbia regarding their addiction treatment benefits and utilization controls in standard and alternative benefit plans in 2014 and 2017, when plans were subject to ACA parity requirements. The number of state plans that provided benefits for residential treatment and opioid use disorder medications increased substantially. States imposing annual service limits on outpatient addiction treatment decreased by over 50 percent. Fewer states required preauthorization for services, with the largest reductions for medications treating opioid use disorder. The ACA may have prompted state Medicaid programs to expand addiction treatment benefits and reduce utilization controls in alternative benefit plans. This trend was also observed among standard Medicaid plans not subject to ACA parity laws, which suggests a potential spillover effect.
Collapse
Affiliation(s)
- Christina M Andrews
- Christina M. Andrews ( ) is an assistant professor in the College of Social Work, University of South Carolina, in Columbia
| | - Colleen M Grogan
- Colleen M. Grogan is a professor in the School of Social Service Administration, University of Chicago, in Illinois
| | - Bikki Tran Smith
- Bikki Tran Smith is a PhD student in the School of Social Service Administration, University of Chicago
| | - Amanda J Abraham
- Amanda J. Abraham is an assistant professor in the School of Public and International Affairs, University of Georgia, in Athens
| | - Harold A Pollack
- Harold A. Pollack is the Helen Ross Professor in the School of Social Service Administration, University of Chicago
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences in the Department of Psychiatry, Stanford School of Medicine, and a senior research career scientist at the Veterans Affairs Palo Alto Health Care System, both in California
| | - Melissa A Westlake
- Melissa A. Westlake is a PhD student in College of Social Work, University of South Carolina
| | - Peter D Friedmann
- Peter D. Friedmann is chief research officer for academic affairs at Baystate Health, in Springfield, Massachusetts
| |
Collapse
|
8
|
Niedzwiecki MJ, Sharma PJ, Kanzaria HK, McConville S, Hsia RY. Factors Associated With Emergency Department Use by Patients With and Without Mental Health Diagnoses. JAMA Netw Open 2018; 1:e183528. [PMID: 30646248 PMCID: PMC6324434 DOI: 10.1001/jamanetworkopen.2018.3528] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE An association between frequent use of the emergency department (ED) and mental health diagnoses is frequently documented in the literature, but little has been done to more thoroughly understand why mental illness is associated with increased ED use. OBJECTIVE To determine which factors were associated with higher ED use in the near future among patients with and without mental health diagnoses. DESIGN, SETTING, AND PARTICIPANTS A retrospective case-control study of all patients presenting to the ED in California in 2013 using past ED data to predict future ED use. Data from January 1, 2012, through December 31, 2014, from California's Office of Statewide Health Planning and Development were analyzed. MAIN OUTCOMES AND MEASURES Factors associated with higher ED use in the year following an index visit for patients with vs without a mental health diagnosis. RESULTS Among the 3 446 338 individuals in the study (accounting for 7 678 706 ED visits), 44.6% (1 537 067) were male; 31.6% (1 089 043) were between the ages of 18 and 30 years, 40.3% (1 338 874) were between the ages of 31 and 50 years, and 28.1% (968 421) were between the ages of 51 and 64 years. The mean (SD) number of ED visits per patient per year was 1.69 (2.56), and 29.1% of patients (1 002 884) had at least 1 mental health diagnosis. Previous hospitalization and high rates of lagged ED visits were associated with higher future ED use. The severity of the mental health diagnosis (mild, moderate, or severe) was associated with increased ED visits (incidence rate ratio [IRR], 1.029; 95% CI, 1.02-1.04 for mild; IRR, 1.121; 95% CI, 1.11-1.13 for moderate; and IRR, 1.226; 95% CI, 1.22-1.24 for severe). Little evidence was found for interaction effects between mental health diagnoses and other diagnoses in predicting increased future ED use. CONCLUSIONS AND RELEVANCE Certain classes of mental health diagnoses were associated with higher ED use. The presence of a mental illness diagnosis did not appear to interact with other patient-level factors in a way that meaningfully altered associations with future ED use.
Collapse
Affiliation(s)
- Matthew J. Niedzwiecki
- Mathematica Policy Research, Oakland, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
| | - Pranav J. Sharma
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Hemal K. Kanzaria
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
| | | | - Renee Y. Hsia
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
| |
Collapse
|
9
|
Kennedy-Hendricks A, Epstein AJ, Stuart EA, Haffajee RL, McGinty EE, Busch AB, Huskamp HA, Barry CL. Federal Parity and Spending for Mental Illness. Pediatrics 2018; 142:peds.2017-2618. [PMID: 30037977 PMCID: PMC6317554 DOI: 10.1542/peds.2017-2618] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alene Kennedy-Hendricks
- Departments of Health Policy and Management and .,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew J. Epstein
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth A. Stuart
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rebecca L. Haffajee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emma E. McGinty
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Alisa B. Busch
- McLean Hospital, Belmont, Massachusetts; and,Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Colleen L. Barry
- Departments of Health Policy and Management and,Mental Health, and,Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
McGinty EE, Goldman HH, Pescosolido BA, Barry CL. Communicating about Mental Illness and Violence: Balancing Stigma and Increased Support for Services. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2018; 43:185-228. [PMID: 29630706 PMCID: PMC5894867 DOI: 10.1215/03616878-4303507] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In the ongoing national policy debate about how to best address serious mental illness (SMI), a major controversy among mental health advocates is whether drawing public attention to an apparent link between SMI and violence, shown to elevate stigma, is the optimal strategy for increasing public support for investing in mental health services or whether nonstigmatizing messages can be equally effective. We conducted a randomized experiment to examine this question. Participants in a nationally representative online panel (N = 1,326) were randomized to a control arm or to read one of three brief narratives about SMI emphasizing violence, systemic barriers to treatment, or successful treatment and recovery. Narratives, or stories about individuals, are a common communication strategy used by policy makers, advocates, and the news media. Study results showed that narratives emphasizing violence or barriers to treatment were equally effective in increasing the public's willingness to pay additional taxes to improve the mental health system (55 percent and 52 percent, vs. 42 percent in the control arm). Only the narrative emphasizing the link between SMI and violence increased stigma. For mental health advocates dedicated to improving the public mental health system, these findings offer an alternative to stigmatizing messages linking mental illness and violence.
Collapse
Affiliation(s)
- Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD, 21205, , Phone: 410-614-4018
| | | | | | - Colleen L. Barry
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
11
|
Stewart MT, Horgan CM, Hodgkin D, Creedon TB, Quinn A, Garito L, Reif S, Garnick DW. Behavioral Health Coverage Under the Affordable Care Act: What Can We Learn From Marketplace Products? Psychiatr Serv 2018; 69:315-321. [PMID: 29241429 PMCID: PMC5832546 DOI: 10.1176/appi.ps.201700098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The 2008 federal parity law and the 2010 Affordable Care Act (ACA) sought to expand access to behavioral health services. There was concern that health plans might discourage enrollment by individuals with behavioral health conditions who tend to be higher cost. This study compared behavioral health benefits available in the group insurance market (nonmarketplace) to those sold through the ACA marketplaces to check for evidence of less generous behavioral health coverage in marketplace plans. METHODS Data were from a 2014 nationally representative survey of commercial health plans regarding behavioral health services (80% response rate). The sample included the most common silver marketplace product and, as a comparison, the most common nonmarketplace product of the same type (for example, health maintenance organization or preferred provider organization) from each health plan (N=106 marketplace and nonmarketplace pairs, or 212 products). RESULTS Marketplace and nonmarketplace products were similar in terms of coverage, prior authorization, and continuing review requirements. Marketplace products were more likely to employ narrow and tiered behavioral health provider networks. Narrow and tiered networks were more common in state than in federal marketplaces. CONCLUSIONS Provider network design is a tool that health plans may use to control cost and possibly discourage enrollment by high-cost users, including those with behavioral health conditions. The ACA was successful in ensuring robust behavioral health coverage in marketplace plans. As the marketplaces evolve or are replaced, these data provide an important baseline to which future systems can be compared.
Collapse
Affiliation(s)
- 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
| | - 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
| | - 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
| | - 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
| | - Amity 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
| | - Lindsay Garito
- 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
|
12
|
Cummings JR, Allen L, Clennon J, Ji X, Druss BG. Geographic Access to Specialty Mental Health Care Across High- and Low-Income US Communities. JAMA Psychiatry 2017; 74:476-484. [PMID: 28384733 PMCID: PMC5693377 DOI: 10.1001/jamapsychiatry.2017.0303] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance With the future of the Affordable Care Act and Medicaid program unclear, it is critical to examine the geographic availability of specialty mental health treatment resources that serve low-income populations across local communities. Objectives To examine the geographic availability of community-based specialty mental health treatment resources and how these resources are distributed by community socioeconomic status. Design, Setting, and Participants Measures of the availability of specialty mental health treatment resources were derived using national data for 31 836 zip code tabulation areas from 2013 to 2015. Analyses examined the association between community socioeconomic status (assessed by median household income quartiles) and resource availability using logistic regressions. Models controlled for zip code tabulation area-level demographic characteristics and state indicators. Main Outcomes and Measures Dichotomous indicators for whether a zip code tabulation area had any (1) outpatient mental health treatment facility (more than nine-tenths of which offer payment arrangements for low-income populations), (2) office-based practice of mental health specialist physician(s), (3) office-based practice of nonphysician mental health professionals (eg, therapists), and (4) mental health facility or office-based practice (ie, any community-based resource). Results Of the 31 836 zip code tabulation areas in the study, more than four-tenths (3382 of 7959 [42.5%]) of communities in the highest income quartile (mean income, $81 207) had any community-based mental health treatment resource vs 23.1% of communities (1841 of 7959) in the lowest income quartile (mean income, $30 534) (adjusted odds ratio, 1.74; 95% CI, 1.50-2.03). When examining the distribution of mental health professionals, 25.3% of the communities (2014 of 7959) in the highest income quartile had a mental health specialist physician practice vs 8.0% (637 of 7959) of those in the lowest income quartile (adjusted odds ratio, 3.04; 95% CI, 2.53-3.66). Similarly, 35.1% of the communities (2792 of 7959) in the highest income quartile had a nonphysician mental health professional practice vs 12.9% (1029 of 7959) of those in the lowest income quartile (adjusted odds ratio, 2.77; 95%, 2.35-3.26). In contrast, outpatient mental health treatment facilities were less likely to be located in the communities in the highest vs lowest income quartiles (12.9% [1025 of 7959] vs 16.5% [1317 of 7959]; adjusted odds ratio, 0.43; 95% CI, 0.37-0.51). More than seven-tenths of the lowest income communities with any resource (71.5% [1317 of 1841]) had an outpatient mental health treatment facility. Conclusions and Relevance Mental health treatment facilities are more likely to be located in poorer communities, whereas office-based practices of mental health professionals are more likely to be located in higher-income communities. These findings indicate that mental health treatment facilities constitute the backbone of the specialty mental health treatment infrastructure in low-income communities. Policies are needed to support and expand available resources for this critical infrastructure.
Collapse
Affiliation(s)
- Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health
| | - Lindsay Allen
- Department of Health Policy and Management, Rollins School of Public Health
| | - Julie Clennon
- Department of Biostatistics, Rollins School of Public Health
| | - Xu Ji
- Department of Health Policy and Management, Rollins School of Public Health
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health
| |
Collapse
|
13
|
Knudsen HK, Studts JL. Perceived Impacts of the Affordable Care Act: Perspectives of Buprenorphine Prescribers. J Psychoactive Drugs 2017; 49:111-121. [PMID: 28296579 DOI: 10.1080/02791072.2017.1295335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Affordable Care Act (ACA) has been heralded as a major policy change that is expected to transform the delivery of substance use disorder (SUD) treatment. Few studies have reported on the perceived impacts of ACA from the perspectives of SUD treatment providers, such as physicians who prescribe buprenorphine to patients with opioid use disorder. The present study describes buprenorphine prescribers' perceptions regarding impacts of the ACA on the delivery of buprenorphine and examines whether state-level approaches to implementing ACA are associated with its perceived impacts. Data are drawn from a national sample of current buprenorphine prescribers (n = 1,174) who were surveyed by mail. On average, buprenorphine prescribers reported ambivalence regarding the impacts of the ACA, as indicated by a mean of 2.75 (SD = 0.69) on a scale that ranged from 1 ("strongly disagree") to 5 ("strongly agree"). A multi-level mixed-effects regression model indicated that physicians practicing in states that were supportive of ACA, as indicated by adopting both the Medicaid expansion and implementing a state-based health insurance exchange, had more positive perceptions of the ACA than physicians in states that had declined both of these policies. This study suggests that state approaches to ACA may be associated with varied impacts.
Collapse
Affiliation(s)
- Hannah K Knudsen
- a Associate Professor, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Jamie L Studts
- b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| |
Collapse
|
14
|
Stuart EA, McGinty EE, Kalb L, Huskamp HA, Busch SH, Gibson TB, Goldman H, Barry CL. Increased Service Use Among Children With Autism Spectrum Disorder Associated With Mental Health Parity Law. Health Aff (Millwood) 2017; 36:337-345. [PMID: 28167724 PMCID: PMC8320748 DOI: 10.1377/hlthaff.2016.0824] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care services for children with autism spectrum disorder are often expensive and frequently not covered under private health insurance. The 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was viewed as a possible means of improving access by eliminating differences between behavioral health and medical/surgical benefits. We examined whether the legislation was associated with increased use of and spending on mental health care and functional services for children with autism spectrum disorder compared to the period prior to implementation of the law. We used nationwide health insurance commercial group claims data to examine trends in service use and spending among children with autism spectrum disorder before and after implementation of the law. For such children, implementation was associated with increased use of both mental health and non-mental health services. These increases in use were not associated with higher out-of-pocket spending, which suggests that the law improved financial protection for families.
Collapse
Affiliation(s)
- Elizabeth A Stuart
- Elizabeth A. Stuart is associate dean for education, a professor in the Departments of Mental Health, Biostatistics, and Health Policy and Management, and codirector of the Center for Mental Health and Addiction Policy Research, all at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Emma E McGinty
- Emma E. McGinty is an assistant professor in the Departments of Health Policy and Management and Mental Health and Core Faculty of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
| | - Luther Kalb
- Luther Kalb is a doctoral student in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts
| | - Susan H Busch
- Susan H. Busch is a professor of public health and chair of the Department of Health Policy and Management, Yale University School of Public Health, in New Haven, Connecticut
| | - Teresa B Gibson
- Teresa B. Gibson is senior director at Truven Health Analytics in Ann Arbor, Michigan
| | - Howard Goldman
- Howard Goldman is a professor in the Department of Psychiatry, University of Maryland School of Medicine, in Baltimore
| | - Colleen L Barry
- Colleen L. Barry is the Fred and Julie Soper Professor and chair of the Department of Health Policy and Management and codirector of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
15
|
Abstract
One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. "Better enforcement" of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured.
Collapse
Affiliation(s)
- Thomas G McGuire
- Thomas G. McGuire is a professor of health economics in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts, and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
| |
Collapse
|