Objective: Utilization of mental health services is a rare, episodic event that reflects the underlying variation in diagnosis and severity, family circumstances, and attitudes towards use. Many of these factors are not observable to the researcher. Moreover, the behavioral health carve-out includes features that lower the barriers for routine, low-intensity use while increasing obstacles to more intense utilization. We adopt a 4-pronged statistical approach to address the research and resultant policy concerns. Approach: To examine the net financial impact of the carve-out, we perform a pre-post, multivariate regression analysis of changes in costs. Using a random-effects model that helps to control biases due to unobserved patient heterogeneity, we explore the ultimate financial impact of the carve-out for patients and for the firm. We perform a multinomial logistic regression analysis to capture different program effects on high-intensity and low-intensity utilization. A fixed-effects negative binomial regression explicitly models the episodic nature of outpatient care, allows one to control for patient-specific unobserved characteristics that influence the likelihood of service use, and accommodates the tremendous variation in service use across patients that is not fully captured by specific diagnoses and other observed factors. Results. The carve-out is estimated to reduce outpatient expenditures at a clinically significant, but relatively modest and statistically insignificant level. The carve-out had a much larger impact on the distribution of burden between patients and the firm (patients: +140 %; firm: -25% (P<.001)). Conclusions: Findings indicate both the promise and the dangers of managed care in the mental health arena.
Learning Objectives: Learner will be able to identify features of a mental health carve-out; analytic techniques used to assess outcomes of utilization and cost analyses; understand the impact on users and policymakers of such programs and methods
Keywords: Carve Outs, Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.