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APHA Scientific Session and Event Listing

Alisa B. Busch, MD, MS¹, Haiden A. Huskamp, PhD², Howard H. Goldman, MD, PhD³, and Richard G. Frank, PhD². (1) McLean Hospital Alcohol and Drug Abuse Treatment Program, Harvard Medical School, Proctor Building, 115 Mill Street, Belmont, MA 02478, (2) Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, (3) Department of Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, Baltimore, MD 21201, 310-983-1671, hh.goldman@verizon.net

To determine whether a parity policy for federal employees was associated with changes in the quality for major depression treatment, we examined indicators of quality of care for major depression using archival health plan enrollment and claims/encounter data from seven large health plans. Analyses tracked quality indicators for two years before (1998-1999) and two years after (2000-2001) parity mandates for federal employees were implemented. Quality indicators included rates of identifying adults with major depression since these disorders are often undetected. Using existing guidelines and recommendations, we defined seven indicators of treatment quality among those with major depression. There was no change in the major depression identification rate from pre- to post-parity implementation. Post-parity, several plans improved significantly in the likelihood of receiving antidepressants medication. In the acute phase episodes, the greatest improvement was seen in the likelihood of follow-up >=4 months. Few or no other changes were observed in the acute phase treatment intensity or duration quality measures. Implementation of parity was not associated with declines in quality of behavioral health care, even though health plans had the opportunity to tighten controls over utilization through managed care. Parity was associated with modest improvements, but the observed improvements were consistent with secular trends in treatment of major depression. Policies that mandate parity of insurance benefits for mental health conditions are not likely to adversely affect the quality of care for these conditions, however, improving the financing of care may not be sufficient to improve quality.

Learning Objectives:

• Articulate the methods for evaluating quality of care for major depression
• Describe the impact of parity on quality of care for major depression
• Identify the limits to generalizability of the findings from the FEHB program

Keywords: Mental Health, Substance Abuse

Presenting author's disclosure statement:

Any relevant financial relationships? No