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


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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