Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

The Effects of Federal Parity on Substance Use Disorder Treatment_Andrew Epstein 5_7_13

495 views

Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

The Effects of Federal Parity on Substance Use Disorder Treatment_Andrew Epstein 5_7_13

  1. 1. The effects of federal parity on substance use disorder treatmentSusan H. Busch, PhD;1 Andrew J. Epstein, PhD;2,3 Michael O. Harhay, MPH;2 David A. Fiellin, MD;1Hyong Un, MD;4 Deane Leader Jr;4 Colleen L. Barry, PhD MPP51 Yale University; 2 University of Pennsylvania; 3 Veterans Affairs; 4 Aetna Inc; 5 Johns Hopkins University Analyses focused on enrollees in 10 states withpre-existing SUD parity laws Under ERISA, fully insured plans are subject tostate parity laws, but self-insured plans areexempt Compared pre-post changes in outcomes amongindividuals newly subject to federal parity withchanges among individuals already subject topre-existing state SUD laws Used difference-in-differences models Controlled for enrollee gender, age and state Logistic regression for binary outcomes Two-part models for spending outcomes Method of recycled predictions andnonparametric block bootstraps to calculateeffect size and confidence intervalsMethods Results Concern that federal parity wouldgreatly increase health care spending,at least related to SUD treatment, wasunfoundedPolicy Implications Historically, more stringent limits on coveragefor mental health and substance use disorder(SUD) services In 2008, the U.S. Congress enacted the PaulWellstone and Pete Domenici Mental HealthParity and Addiction Equity Act (MHPAEA) Required insurers to equalize privateinsurance coverage for mental health and SUDservices with coverage for general medicalservices Includes all financial requirements andtreatment limits Effective January 1, 2010 Expected effects of parity on SUD treatmentare ambiguous, and no published informationis yet availableBackground To examine the effects of the MHPAEA onsubstance use disorder treatmentObjectivesFunded by NIH grantsNIDA DA026414 andNIMH MH093414-01A1 Aetna claims data for members continuouslyenrolled during 2009 (pre) and 2010 (post) Annual total SUD spending per enrolleeincludes all SUD-related inpatient, partialhospitalization, intensive outpatient, andoutpatient services, and Rx drugsData and MeasuresBaseline characteristics of study sample, 2009Probability of use & spending per enrollee onSUD servicesOut-of-pocket (OOP) SUD spending per userHEDIS measures: IdentificationHEDIS measures: Treatment initiationHEDIS measures: Treatment engagement No change in use of any SUD services Small increase in total annual SUD cost perenrollee (i.e., $10 per enrollee per year) No change in OOP spending per SUD user No change in HEDIS measuresSummary of findingsSelf insured(N=162,761)Fully insured(N=135,578)(p-value)N (%) N (%)Female 84,530 (54.1) 71,755 (52.9) p<0.001Age p<0.00118-31 years 40,520 (24.9) 35,205 (26.0)32-46 years 63,903 (39.3) 50,870 (37.5)47-62 years 58,338 (35.8) 49,503 (36.5)Selected diagnoses• Any substance use disordertreatment1,752 (1.1%) 912 (0.7%) p<0.001• Any alcohol usedisorder treatment653 (0.4) 342 (0.3) p<0.001• Any illicit drug use disordertreatment1,099 (0.7) 570 (0.4) p<0.001• Any opioid usedisorder treatment323 (0.2) 166 (0.1) p<0.001Change in value beforeand after parityProbability ofusing SUDtreatment (%)Total SUDspending perenrollee ($)Probabilityof using SUDservices (%)Total SUDspendingper enrollee ($)PreparityPostparityPreparityPostparity95% CI 95% CISelf insuredtreatmentgroup(N=162,761)1.04 1.18 36.51 52.620.05[-0.03, 0.12]9.99[2.54, 18.21]Fully insuredcomparisongroup(N=135,578)0.70 0.79 26.58 32.70OOP spending for SUDservicesper user ($)Change in valuebefore and afterparity ($)PreparityPostparity95% CISelf insuredtreatment group449.48 538.7039.00[-71.05, 145.13]Fully insuredcomparison group572.23 622.45Identification of SUDservice receipt (%)Change in valuebefore and afterparity (%)PreparityPostparity95% CISelf insuredtreatment group0.81 0.910.01[-0.074, 0.94]Fully insuredcomparison group0.53 0.62Treatment initiation (%)Change in value beforeand after parityPreparityPostparity% 95% CISelf insuredtreatment group34.71 33.330.44 [-5.07, 6.40]Fully insuredcomparison group32.63 30.81Treatment engagement(%)Change in value beforeand after parityPreparityPostparity% 95% CISelf insuredtreatment group19.29 19.571.84 [-2.79, 6.65]Fully insuredcomparison group19.40 17.84

×