Contrary to Expectations, Benefits Levels Do Not Affect Use of Behavioral Health Services/Age and Sex Not Factors Either
As part of a multi-phase research collaborative, ValueOptions and Harvard Medical School Faculty in the Division on Addictions (DOA) at an affiliated teaching hospital in the Boston area completed the final phase of a study to better understand patterns in the demand for behavioral health services.
The study looked at inpatient and outpatient levels of behavioral health care over a three-year period from January 2002 through December 2004 using millions of claims obtained from four regional health plans located in the Mid-Atlantic and Northeast. The goal of the study was to determine the extent to which the following factors influenced service cost and units of service:
1. Member characteristics (e.g., age, gender, and diagnosis);
2. Provider access (defined as the number of providers within the member's zip code);
3. Benefit design (e.g., the existence of deductibles, co-pays, and/or coinsurances); and
4. Product line (e.g., HMO, PPO, POS).
Contrary to expectations, a member’s diagnosis was the only variable that predicted service costs and units. The member’s age and gender, the number of available providers, the benefit design, and the product line did not add to estimation of service costs or utilization.
The study revealed additional key findings:
1. Approximately 0.8 percent of members utilized inpatient services, and 8.6 percent had at least one claim for outpatient services.
2. The most common outpatient services diagnostic category was depression, followed by adjustment disorders and anxiety disorders. These three diagnostic categories made up 75 percent of all outpatient claims. For inpatient services, depression was the most common diagnosis, followed by bipolar disorder, alcohol-related, and adjustment disorders.
3. The vast majority of members were covered by an HMO plan (70 percent); the remaining members had POS plans (20 percent) or PPO plans (10 percent).
4. Females comprised the majority (60 percent) of the study sample which had an average age of 35.
5. Nearly one-fourth of all members received services for more than one diagnosis. Moreover, the occurrence of multiple diagnoses was significantly related to an increased cost of services.
6. Depression and bipolar disorder were related to increased cost and requested units of service. Schizophrenic disorders were related to increased inpatient services costs.
About ValueOptions
ValueOptions, the nation’s largest independent behavioral health care company, covers more than 23 million individuals through a variety of direct contracts with health plans, employers, as well as through state and county agencies. ValueOptions is a national managed care company that specializes in disease management for all mental health and chemical dependency diagnoses.
About the Division on Addictions
The Division on Addictions directs educational, medical, and scientific resources toward alleviating the vast and complex array of public heath problems caused by addictive behaviors. The Division conducts research, and a program of education, training, and communication relevant to addictive disorders. For more information, please visit www.divisiononaddictions.org.