General medical and pharmacy claims expenditures in users of behavioral health services

Abstract

OBJECTIVE:To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS:Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS:The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/ or administrative approaches that reverse the high use of general medical resources in behavioral health patients. T he evaluation and treatment of mental disorders causing emotional or behavioral difficulties and/or chemical dependence, collectively known as behavioral health disorders, have been effectively separated from the evaluation and treatment of general medical disorders. Most of those with health care coverage for behavioral health needs are served by managed behavioral health organizations.1,2 These management companies operate autonomously either from the managed medical care organization administering general medical benefits to the same patients (a behavioral health carve-out) or from the parent managed care organization which owns the behavioral health business (a behavioral health carve-in) but still manages behavioral health work processes (networks, care management, claims, etc.) separately. In practice, there is little difference between the two in the way that they service behavioral health needs. As a result of the widespread administrative separation of these two areas of health care, few studies have focused on the interaction of general medical, pharmacy, and behavioral health service use in those receiving behavioral health treatment. This article expands on our current understanding of the magnitude, persistence, and interaction of behavioral h...

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