High Deductible Health Plans Impact Employee Mental Healthcare

Employee mental healthcare spending rose, and employer mental healthcare spending fell after employers transitioned their workers from preferred provider organizations to high deductible health plans, a study from the Employee Benefit Research Institute (EBRI) found.

The researchers focused on individuals who had been diagnosed with one of three specific mental health conditions to assess the impact of transitioning from a preferred provider organization to a high-deductible health plan: anxiety, attention deficit hyperactive disorder (ADHD), and major depressive disorder (depression).

The study received funding from a handful of organizations, including the Blue Cross Blue Shield Association, the Independent Colleges and Universities Benefits Association (ICUBA), Pfizer, and PhRMA.

Moving from preferred provider organizations to high deductible health plans—which can form a type of consumer-driven health plan—resulted in a drop in the probability of healthcare utilization, the study found.

The likelihood of receiving care from a particular source varied by condition and site or type of care. 

All three conditions saw considerable decreases in the probability of receiving care from a mental health office after switching to a high deductible health plan. Individuals with depression were 18 percent less likely to go to a mental health office, those with ADHD were 15 percent less likely, and those with anxiety were 14 percent less likely to seek care at this site.

Inpatient hospital admissions also dropped significantly for participants with depression (19 percent less likely to visit) and anxiety (16 percent less likely to visit). However, employees with ADHD were not as severely impacted (six percent less likely to visit).

Employees with ADHD were less likely to visit specialty offices than employees with depression or anxiety. Employees with ADHD were also less likely to fill their prescription drugs. However, for specific medications, individuals with depression or anxiety were less likely to fill their prescriptions.

Additionally, the quantity of utilization within the services was lower. For example, utilization of mental health providers’ services was lower by 68 employees with ADHD out of 100 employees.

“Note that these reductions in use of services represent a reduction of less than one office visit per member,” the study mentioned.

The utilization of preventive care services dropped when participants switched to a high deductible health plan. 

For employees with anxiety or depression, women’s breast cancer and cervical cancer screenings and men’s prostate-specific antigen and lipid tests dropped after the employees switched to high deductible health plans. Employees with anxiety saw influenza vaccinations decline 2.6 percent, and pneumonia vaccinations declined 1.5 percent among those with depression.

Out-of-network services were one service area that showed mixed results regarding utilization trends after the transition. Out-of-network mental health visits declined for employees with ADHD (18 percent) and depression (12 percent). Apart from that, out-of-network service utilization trends after switching to a high deductible health plan were not significant.

Employer healthcare spending fell, and employee healthcare spending rose when employees transitioned to a high deductible health plan due to these declines in healthcare utilization and shifting payment responsibility to the employee.

When employers switched their employees into high deductible health plans, overall spending for depression, anxiety, and ADHD dropped by $1,137, $984, and $868. Employers saw over $1,000 in decreased spending for each of these conditions. However, employees saw spending increase by $326 for depression, $321 for anxiety, and $281 for ADHD.

Inpatient hospital spending decreased significantly for each condition. ADHD also saw a significant drop in prescription drug fill spending. 

The researchers noted one fundamental limitation to the study. They could not assess the value of participants' care in either the preferred provider organization or the high deductible health plan.

Nevertheless, the researchers indicated that high deductible health plans could be improved if employers apply value-based care to their high deductible health plan benefit design.

“Smarter deductibles accommodating services preventing the exacerbation of chronic conditions might be a natural evolution of health plans,” the study concluded. “Interventions that improve patient-centered outcomes while maintaining affordability may be found in the form of a clinically nuanced health plan that better meets workers’ clinical and financial needs.”