Impact of Behavioral Health Homes on Cost and Utilization Outcomes

Highland, James; Nikolajski, Cara; Kogan, Jane N.; Ji, Yang; Kukla, Matt; Schuster, James M.

doi:10.1176/appi.ps.201900141

Cited by 12 publications

(6 citation statements)

References 13 publications

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“…Previous studies have been specific to individual conditions within controlled research settings. [10][11][12]23,24 Our findings suggest that promoting OPBHT as part of a population health strategy is associated with improved overall medical spending, particularly among adults. Future research should validate these findings in other populations, including government-insured individuals, and explore data by chronic disease category, over longer time horizons, by type and quality of OPBHT, by type of medical spending, within subpopulations with BHCs, and including virtual and digital behavioral health services.…”

Section: Jama Network Open | Psychiatrymentioning

confidence: 89%

“…1 Individuals with a BHC incur 2.8 to 6.2 times greater medical costs than those without a BHC, which could be explained in part by linkages between mental health conditions and highly prevalent chronic conditions. [2][3][4][5][6][7] While widescale cost-effectiveness of interventions developed to treat BHCs and also improve medical health outcomes has not been established, 8,9 several promising studies have indicated statistically significant medical cost savings associated with improved antidepressant adherence, 10 use of behavioral health homes, 11 and substance use interventions. 12 Despite this evidence, diagnosis of BHCs is often delayed 13 and the majority of the population with a BHC receives little to no treatment in any given year.…”

Section: Introductionmentioning

confidence: 99%

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Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

Bellon¹,

Quinlan²,

Taylor³

et al. 2022

JAMA Netw Open

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ImportanceOutpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established.ObjectiveTo investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT.Design, Setting, and ParticipantsThis retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021.ExposuresReceipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits.Main Outcomes and MeasuresThe main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders.ResultsThe study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P &lt; .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P &lt; .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT.Conclusions and RelevanceIn this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.

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Section: Jama Network Open | Psychiatrymentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

Bellon¹,

Quinlan²,

Taylor³

et al. 2022

JAMA Netw Open

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“…Some have gone so far as to build behavioral health homes for SMI patients, a form of reverse integration where components of medical care are embedded into a unit focused on serious mental health needs. [5][6][7] Despite these advances in our conceptual knowledge, given the numerous design options and management decisions necessary to create functioning integrated mental health services, the implementation handbook remains comparatively thin. 8,9 Understanding this broader context and current trends toward integrated mental health care delivery may be the easiest part.…”

Section: All Of This Requires Design Input and Clinical Backup From Pmentioning

confidence: 99%

“…Clearly the more specialized services required for moderate to severe mental illness go well beyond what the typical integrated primary setting can offer. Some have gone so far as to build behavioral health homes for SMI patients, a form of reverse integration where components of medical care are embedded into a unit focused on serious mental health needs 5‐7 . Despite these advances in our conceptual knowledge, given the numerous design options and management decisions necessary to create functioning integrated mental health services, the implementation handbook remains comparatively thin 8,9…”

mentioning

confidence: 99%

A blueprint for integrated mental health care

Chang

Ferris

2020

Health Services Research

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A blueprint for integrated mental health care Commentary for "Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system" The long-standing debate over how best to organize services and payment policies for mental health has hinged on how we choose to simplify the multiple complex connections of mental health conditions with other human ailments. Because mental health problems can be legitimately viewed as highly distinct from, or, alternatively, necessarily intertwined with, medical conditions, policies have vacillated between encouraging or discouraging integration of mental health services with other medical services. Both approaches have

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“…Furthermore, at the time of this report, the financial impact of COVID-19-related mandates on many smaller, community-based MH centers is unknown but expected to strain limited resources and state Medicaid budgets (Garrett & Gangopadhyaya, 2020). As a result, managed care organizations look to practical strategies that address SDoH while decreasing high-cost, acute service utilization (such as inpatient MH and SUD treatment and withdrawal management) and linking individuals to ambulatory care as a secondary prevention effort (Brar et al, 2021;Gottlieb et al, 2016Gottlieb et al, , 2017Highland et al, 2020).…”

mentioning

confidence: 99%

Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission

Hutchison¹,

Herschell²,

Edwards³

et al. 2022

Professional Case Management

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ocioeconomic and basic needs, as well as conditions of an individual's environment, also known as social determinants of health (SDoH), may exacerbate illness symptoms and contribute to rates of unplanned emergent care and hospitalization. Within behavioral health care, SDoH have been named as potential contributors to the "revolving door" of inpatient readmissions (Habit et al., 2018). The demand for health care systems to help facilitate linkages to community-based services and resources, support the provider network, and understand the needs of individuals is critical to making an impact on whole person health as well as population health.Likely in part of negative repercussions of coronavirus disease-2019 (COVID-19) on unemployment, rates of individuals covered under Medicaid have increased, with economic recovery expected to occur over the next 2 years or longer (Corallo & Rudowitz, 2021; Health Management Associates, 2020). Management of the increase in Medicaid enrollment is especially challenging at this time, as rates of behavioral health issues, which include mental health (MH) disorders and substance use disorders (SUDs), have increased and symptoms have

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Impact of Behavioral Health Homes on Cost and Utilization Outcomes

Cited by 12 publications

References 13 publications

Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

A blueprint for integrated mental health care

Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission

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