Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

IMPORTANCE

Outpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established.

OBJECTIVE

To investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021.

EXPOSURES

Receipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits.

MAIN OUTCOMES AND MEASURES

The main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders.

RESULTS

The study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P < .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P < .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT.

CONCLUSIONS AND RELEVANCE

In this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.

Loneliness influences avoidable absenteeism and turnover intention reported by adult workers in the United States

Purpose

Loneliness is known to adversely impact employee health, performance and affective commitment. This study involves a quantitative cross-sectional analysis of online survey data reported by adults employed in the United States (n = 5,927) to explore how loneliness and other related factors may influence avoidable absenteeism and turnover intention.

Design/methodology/approach

Worker loneliness was assessed using the UCLA Loneliness Scale (Version 3). Composite variables were constructed as proxy measures of worker job and personal resources. Structural equation modeling (SEM) was used to examine independent variable effects on dependent outcomes of (a) work days missed in the last month due to stress (stress-related absenteeism) and (b) likelihood to quit within the next year (turnover intention).

Findings

The job resources of social companionship, work-life balance and satisfaction with communication had significant negative relationships to loneliness in the SEM, as did the personal resources of resilience and less perceived alienation. Results further show lonely workers have significantly greater stress-related absenteeism (p = 0.000) and higher turnover intention ratings (p = 0.000) compared to workers who are not lonely. Respondent demographics (age, race and gender) and other occupational characteristics also produced significant outcomes.

Practical implications

Study findings underscore the importance of proactively addressing loneliness among workers and facilitating job and personal resource development as an employee engagement and retention strategy.

Originality/value

Loneliness substantially contributes to worker job withdrawal and has negative implications for organizational effectiveness and costs.