Contrary to the hysterical warnings issued by the insurance industry and the Chamber of Commerce, it turns out that parity for addiction treatment does not add significantly to costs. One key reason is underutilization. Replacing the expensive and minimally effective rehab approach with a fully professional, scientifically based approach will not only make treatment even more cost effective, it will increase access to and utilization of treatment.
From Medscape Medical News > Psychiatry
No Increase in Substance Abuse Treatment Due to Mental Health Parity Law
Findings Should Squelch Fears That Controversial Legislation Will Cause Health Costs to Skyrocket
February 4, 2011 — Parity in insurance coverage of substance abuse treatment has not led to increased use of this service or an increase in costs. It has done what it was designed to do — lower out-of-pocket expenses for covered individuals, new research suggests.
Employers who provide health insurance plans for mental and substance use disorders are now required by the Federal Mental Health Parity Act of 2008 to provide benefits that are equal to those given for general medical care.
There is always a fear that for substance abuse and for mental health, every time a plan is more generous, utilization will skyrocket...But this is not true.
"There is always a fear that for substance abuse and for mental health, every time a plan is more generous, the utilization will skyrocket, the costs will be so high, and all the insurance companies will start complaining that they won't be able to afford these services. But this is not true," lead study author Vanessa Azzone, PhD, researcher and biostatistician in the Department of Health Care Policy at Harvard Medical School in Boston, Massachusetts, told Medscape Medical News.
"I think these findings, along with those found in other studies, clear the air for all the people who have been criticizing parity law for mental health treatment," said Dr. Azzone.
The investigators note that the extensive use of managed care organizations (MCOs) within employer-based health insurance may be the reason for costs not rising.
"These MCOs administer behavioral health benefits and contain costs by managing the delivery of care — for example, through negotiated reduction in fees with a network of preferred providers and review of appropriateness of services to eliminate unnecessary use," they explain.
"Still, it's always a balance between getting more for the patient but also, from the plan side, controlling that services are only provided as needed," added Dr. Azzone.
The study is published in the February issue of Psychiatric Services.
Paucity of Research
Although previous research on the impact of mental health parity mandates "has undoubtedly helped to pave the way for passage of comprehensive federal legislation," there have been few studies on the effects of parity mandates for substance abuse treatment benefits, write the study authors.
"This is a group that is not studied as much. They're pretty sick and their services are very expensive. So there's been fear that the parity law could have a real impact," said Dr. Azzone.
Insurance plans for federal workers have been required to provide parity coverage since 2001. Because of this, the investigators decided to evaluate claims data on substance abuse treatment in 6 Federal Employees Health Benefit (FEHB) preferred provider organization plans between 1999 and 2001 (before parity was implemented) and between 2001 and 2002 (after implementation).
The use and costs of these plans were then compared with those found in a matched set of health plans without parity coverage.
Results showed no statistically significant differences in the use of substance abuse treatment services between the 2 plan types and no significant differences in probability rates of initiation and engagement.
Those enrolled in the FEHB plans had a significantly larger reduction in average out-of-pocket spending for these services (mean difference per user, −$101.09; P < .05) compared with those in the non-FEHB plans.
Although the FEHB group also had smaller increases in total substance abuse spending compared with the non-FEHB group, these differences were not significant.
Finally, more of the patients with parity were identified by their care providers as having a substance use disorder (difference-in-difference risk, 0.10; 95% confidence interval, 0.02 to 0.19; P < .05).
"Findings suggest that for continuously enrolled populations, providing parity of substance abuse treatment coverage improved insurance protection but had little impact on utilization, costs for plans, or quality of care," write the researchers.
Clinicians' 'Biggest Stress'
According to Dr. Azzone clinicians' biggest stress is trying to get paid for services because insurance companies erect so many barriers to reimbursement.
"Still, there is this law, and I think clinicians should push more for their patients, even if it is hard for them to promote services when they have so many obstacles. This is already a population that finds it very hard to engage in and continue to get services," she said.
She added that her team is conducting other studies looking at the possibility of parity coverage differences for other groups.
"This includes patients with bipolar disorder or major depression that usually are more expensive and require more services. These patient populations could have a differential effect. We're also concentrating on children to see if the effect we found in adults overall is the same or not," she explained.
"I think this study is significant and an important step in the analysis of overall healthcare costs," Anita S. Everett, MD, director of Community Psychiatry Services at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, told Medscape Medical News.
Dr. Anita Everett
"Providing parity for substance abuse services didn't increase the overall costs. And that is the big fear that everyone has — open the floodgates and all these people will want these very expensive services," said Dr. Everett, who was not involved with this study.
"Also, the number of individuals who actually sought the services didn't go up that much. I think that that is important, although not shocking, and consistent with what we already know: a lot of people with a substance abuse disorder don't recognize their need for treatment or are unwilling to seek treatment. Offering parity is not all of a sudden going to break down their resistance."
Dr. Everett pointed out that a big part of "substance abuse disease" is to be in denial about the magnitude of the problem.
Parity Law Won't 'Break the Bank'
"The clinical significance of parity is that it enables a clinician to be able to help patients and to 'strike while the iron is hot,' so to speak. If they're at a point where they're ready, then hopefully we'll be able to immediately meet that readiness," she said.
Dr. Everett, who is also chair of the American Psychiatric Association's Council on Healthcare Systems and Finance, said that some primary care physicians might not be aware that the parity law has passed.
"I know that the American Psychiatric Association, along with a number of other organizations, is actively working to promote awareness for healthcare providers, patients, and their families that parity for substance abuse and for mental health services does exist," she said.
"I also think that resources such as referral services should be collected and offered in primary care offices."
I think this is critical information that helps us understand that enabling access to some of these services is not going to break the bank.
She noted that, although these findings are important, the study population might not be representative of all groups in the United States.
"These were people who were fairly motivated and are probably comparable to other private pay insurance groups — but maybe not to the Medicare or Medicaid populations. We know it can give us some ideas about applicability to the general public, but it may or may not be predictive of the other 300 million Americans who are not federal employees," explained Dr. Everett.
"However, I think this is critical information that helps us understand that enabling access to some of these services is not going to break the bank."
The study was funded by a grant from the National Institute on Drug Abuse through the Brandeis-Harvard Center for Managed Care and Drug Abuse Treatment. Its data were originally collected in a study funded by the Department of Health and Human Services. The study authors and Dr. Everett have disclosed no relevant financial relationships.
Psychiatr Serv. 2011;62:129-134.
Medscape Medical News © 2011 WebMD, LLC
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