Three of the coauthors, Robert Spies, Keith Folkert, and William Gold, are employees of Blue Cross Blue Shield of Minnesota. While Blue Cross is currently in the process of identifying ways to better address behavioral health needs for their enrollees, in part due to the results reported in this manuscript, none of these coauthors or Blue Cross Blue Shield of Minnesota anticipate direct or indirect benefit from the publication of this article. The corresponding author, Roger G. Kathol, worked for Blue Cross Blue Shield of Minnesota as medical director at the time the data were collected and initial analyses were performed. He now works as a medical management consultant, addressing issues of health care coordination and could, therefore, indirectly benefit by the publication of this manuscript because it reports data related to the interaction of general medical and behavioral health care service use. The remainder of the authors do not have direct or indirect conflicts of interest.
General Medical and Pharmacy Claims Expenditures in Users of Behavioral Health Services
Article first published online: 25 FEB 2005
Journal of General Internal Medicine
Volume 20, Issue 2, pages 160–167, February 2005
How to Cite
Kathol, R. G., McAlpine, D., Kishi, Y., Spies, R., Meller, W., Bernhardt, T., Eisenberg, S., Folkert, K. and Gold, W. (2005), General Medical and Pharmacy Claims Expenditures in Users of Behavioral Health Services. Journal of General Internal Medicine, 20: 160–167. doi: 10.1111/j.1525-1497.2005.40099.x
- Issue published online: 1 APR 2005
- Article first published online: 25 FEB 2005
- Accepted for publication July 1, 2004
- integrated care;
- cost outcomes;
- managed care expenditures;
- managed behavioral health;
- mental health
Objective: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists.
Design: Retrospective cost trends and 24-month cohort analyses.
Setting: A Midwest health plan.
Participants: Over 250,000 health plan enrollees during 2000 and 2001.
Measurements: Claims expenditures for behavioral health services, general medical services, and prescription medications.
Main Results: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted.
Conclusions: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.