Cost shifting under managed behavioral health care

Area of Science:

• Health Services Research
• Health Economics
• Mental Health Services

Background:

• Managed behavioral health care organizations (MBHOs) aim to control healthcare costs.
• Incentives may encourage MBHOs to shift costs to less expensive treatment modalities.
• This study investigates potential cost-shifting by an MBHO into primary care or prescription drugs.

Purpose of the Study:

• To determine if a managed behavioral health care organization (MBHO) shifted treatment costs.
• To assess the impact of an MBHO on the utilization of psychotropic medications and specialty mental health care.

Main Methods:

• Analysis of four years of claims data (1991-1995) from an insurer that implemented an MBHO in 1992.
• Comparison of enrollees in a large employer group with parity coverage and a group of smaller employers without parity.
• Statistical testing using t tests and generalized estimating equations to evaluate medication use trends.

Main Results:

• Overall psychotropic medication use increased in both large (64%) and smaller (87%) employer groups.
• The introduction of the MBHO was not significantly associated with increased use of psychotropic medication alone.
• A decrease in newer antidepressant use without specialty care was observed in the large group following MBHO introduction.

Conclusions:

• The study found no evidence to support the hypothesis that the MBHO shifted treatment costs.
• The MBHO did not appear to increase the use of psychotropic medications as a substitute for specialty mental health care.