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Factors affecting costs in Medicaid populations with behavioral health disorders
Elsie Freeman1, Catherine A McGuire, John W Thomas
1*Muskie School of Public Service, University of Southern Maine, Portland, ME †Integrated Care Projects, Maine DHHS, Office of Continuous Quality Improvement, Augusta ‡Health Data Resources, Muskie School of Public Service, University of Southern Maine, Portland, ME §Emeritus of Health Policy and Management, University of Michigan, Ann Arbor, MI.
Insights
Individuals with behavioral health (BH) disorders incur higher healthcare costs. This is driven by both BH service utilization and increased medical service use, suggesting integrated care could reduce expenses.
Area of Science:
- Healthcare Economics
- Behavioral Health Services Research
- Health Services Research
Background:
- Individuals with behavioral disorders incur higher healthcare costs.
- They utilize both behavioral health (BH) services and higher levels of medical services compared to the general population.
Purpose of the Study:
- To quantify the contribution of BH service utilization, multiple chronic medical conditions (CMCs), and other BH-specific factors to the elevated healthcare costs in individuals with BH disorders.
- To identify the specific drivers of increased healthcare expenditures in this population.
Main Methods:
- Analysis of claims data from 63,141 Medicaid beneficiaries.
- Utilized generalized linear models to assess the impact of demographics, BH status, CMCs, and primary care access on total, behavioral, nonbehavioral, and medical/surgical costs.
Main Results:
- The number of CMCs significantly increased all cost categories, including behavioral costs.
- The presence of any BH disorder was associated with significant increases in all cost categories, even those unrelated to BH care.
- The magnitude of BH disorder's effect on costs varied across different BH groups.
Conclusions:
- Behavioral health status substantially impacts all healthcare costs, including non-BH medical services.
- The number of CMCs independently influences BH costs, irrespective of a diagnosed BH disorder.
- Integrating behavioral and medical health services may lead to reduced healthcare costs for this population.
Background:
Persons with behavioral disorders incur higher healthcare costs. Although they utilize behavioral health (BH) services others do not, they also have higher utilization of medical services
Objectives:
: To determine the degree to which higher costs for persons with BH disorders are attributable to utilization of BH services, multiple chronic medical conditions (CMCs) or other issues specific to populations with BH disorders.
Research Design:
Data base consisted of claims for 63,141 Medicaid beneficiaries, 49% of whom had one of 5 categories of BH disorder. Generalized linear models were used to identify relative impact of demographics, BH status, multiple CMCs and primary care access on total, behavioral, nonbehavioral, and medical/surgical costs.
Results:
Number of CMCs was associated with significant increases in all cost categories, including behavioral costs. Presence of any BH disorder significantly influenced these same costs, including those not associated with BH care. Effect size in each cost category varied by BH group.
Conclusions:
BH status has a large impact on all healthcare costs, including costs of medical and other non-BH services. The number of CMCs affects BH costs independent of BH disorder. Results suggest that costs might be reduced through better integration of behavioral and medical health services.
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