Impact of Mental Health Comorbidities on Medicare Beneficiaries with Severe and Chronic Disease

Purpose: The objective of this study is to examine the association between major mental health conditions and Medicare service utilization and costs for Medicare FFS beneficiaries with chronic and severe diseases adjusting for multiple comorbidities. Data and Methods: Cross-sectional, observational study of CMS Standard Analytic Files for Inpatient, Outpatient, and Carrier claims data for a 5% nationally representative random sample of FFS Medicare beneficiaries living in the US in 2008 (N=1,838,622) We utilized a generalized linear model with log link and gamma distribution for regression analysis of Medicare costs, and we conducted propensity adjusted multivariate regressions to analyze service utilization of hospitalizations, length of stay, provider encounters, and ER utilization. Results: 56% of our sample population had one or more chronic and severe diseases, and 18% had one or more mental health and substance abuse conditions. Preliminary results show that after adjusting for demographic characteristics, number of comorbidities, and severe and chronic conditions, having a mental health condition was associated with greater annual hospitalizations, length of stay, provider encounters, and total cost of care. Conclusions and Recommendations: Mental health conditions may complicate delivery of health care and lead to greater costs and inefficient utilization of health care resources for Medicare beneficiaries with multiple severe and chronic conditions. This study helps identify Medicare population groups with mental health conditions and multiple comorbidities that new Accountable Care Organizations can target for more efficient and coordinated delivery of care.