Behavioral Health Treatment was Associated with Lower Healthcare Costs

Having one or more outpatient behavioral health treatment (OPBHT) visits was associated with lower healthcare costs among patients with newly diagnosed behavioral health conditions, a JAMA Network Open study found.

Adults with a behavioral health condition incur 2.8 to 6.2 times greater medical costs than those without one, and nearly a quarter of adults had a behavioral health condition as of 2018. However, behavioral health condition diagnoses are often delayed, and most individuals receive little or no treatment each year.

Researchers analyzed commercial insurance claims data from individuals newly diagnosed with one or more behavioral health conditions between January 1, 2017, and December 31, 2018, to determine if those who received OPBHT incurred lower medical and pharmacy costs.

The study compared costs over a 15- and 27-month follow-up period to costs incurred by those who did not have an OPBHT visit.

The sample included 203,401 individuals in the 15-month group and 74,683 people in the 27-month group. Around half of the participants were diagnosed with depression or anxiety, while 11 percent had substance use or alcohol use disorder, and 6 percent had a higher acuity diagnosis such as bipolar disorder, severe depression, eating disorder, psychotic disorder, or autism spectrum disorder.

Additionally, 22 percent of individuals had at least one chronic medical condition along with their behavioral health condition.

Participants who received OPBHT were more likely to be female, White, non-Hispanic, younger than 26, and have an income higher than $100,000 per year, the study noted.

Researchers found that having one or more OPBHT visits was associated with lower medical and pharmacy costs during 15- and 27-month follow-up periods.

For example, the mean per member per month (PMPM) cost over 15 months for those who had OPBHT visits was $571 compared to $686 for those who did not use OPBHT. For the 27-month group, the mean PMPM was $391 for those who received OPBHT compared to $464 for the control group.

The study also aimed to determine whether different quantities of OPBHT visits were associated with cost differences. The analysis found that all doses of OPBHT use were associated with lower costs.

The estimated healthcare cost for the 15-month group was $618 PMPM for one to two visits and $620 for 41 visits or more. In contrast, no OPBHT visits were associated with $681 PMPM. Similarly, in the 27-month group, healthcare costs were $424 PMPM for one to two visits and $397 PMPM for 31 to 40 visits, compared to $466 for no OPBHT visits.

“These findings support the cost-effectiveness of practitioner- and insurance-based interventions to increase OPBHT utilization, which is a critical resource as new [behavioral health condition] diagnoses continue to increase,” researchers wrote.

In addition, the results suggest that promoting OPBHT as a part of a population health strategy can help improve overall medical spending. According to the study, future research should focus on validating this finding among those with government insurance, exploring data by type and quality of OPBHT, and assessing the impact of virtual behavioral health services.

As the COVID-19 pandemic exacerbated the mental and behavioral health crises, payers have worked to increase access to care for members. According to an AHIP survey, all health plan respondents offered virtual behavioral healthcare services as of June 2022.

Payers have also been supporting the behavioral health workforce to help boost access to these services. For example, 78 percent of health plans increased reimbursement rates for behavioral healthcare workers, while 72 percent supported behavioral healthcare training for primary care providers.

Recently, Blue Cross Blue Shield of Massachusetts announced that its mental healthcare services grew by 100 percent and its mental healthcare network grew by 46 percent since 2019. The growth reflects the payer’s partnerships with in-person and virtual providers that helped expand access to mental healthcare for members.