Who leaves managed behavioral health care?

Area of Science:

• Health Services Research
• Behavioral Health Management
• Healthcare Economics

Background:

• Managed care growth raises concerns about potential cost shifting due to enrollment and dis-enrollment biases.
• Understanding enrollment duration is crucial for assessing managed care stability and its impact on healthcare costs.

Purpose of the Study:

• To analyze continuous enrollment duration in managed behavioral health organizations.
• To compare dis-enrollment rates among members with and without behavioral health utilization.
• To examine dis-enrollment patterns across different mental health conditions.

Main Methods:

• Analysis of enrollment data from eleven large employers, covering over 250,000 members in managed behavioral health plans.
• Comparison of dis-enrollment rates based on behavioral health service utilization.
• Stratification of analysis by specific mental health conditions, including depression, substance abuse, and severe disorders.

Main Results:

• Dis-enrollment rates for patients with depression have decreased compared to a decade ago.
• Minimal differences in dis-enrollment exist between users and non-users of behavioral health services, except when coverage is tied to job performance.
• Patients with substance abuse or severe mental health disorders exhibit significantly higher dis-enrollment rates.

Conclusions:

• Managed behavioral health plans show improved retention for depression patients.
• Dis-enrollment is not significantly affected by service use, barring job-performance-linked coverage.
• Higher dis-enrollment risk is associated with substance abuse and severe mental health conditions, indicating potential challenges in long-term care for these populations.