ADHD treatment in a behavioral health care carve-out: medications, providers, and service utilization.
Children's mental health services are increasingly being managed by managed behavioral health organizations (MBHOs) through carve-outs. Little information is available, however, about services and interventions being received by children whose mental health benefits are carved out. Using claims data, this study explores the treatment of children with a common child psychiatric disorder, attention deficit hyperactivity disorder (ADHD). Children being treated for ADHD see a variety of provider combinations. Children diagnosed with comorbid mood or anxiety disorders are more likely to see a psychiatrist than a primary care physician or therapist, and they are more likely to be in treatment with both a psychiatrist and a therapist than with just one mental health professional. After controlling for severity indicators, costs were significantly lower for patients being treated by just a psychiatrist than for patients seeing both a psychiatrist and therapist. This finding raises the possibility that attempts to save money by "splitting treatment" may not be cost-effective.
Stein
B
B
University of Southern California, UCLA/RAND Center for Health Services Research, 1700 Main Street, Santa Monica, CA 90401, USA. stein@rand.org
Orlando
M
M
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D002665:Child Psychiatry / Q000706:statistics & numerical data*; D003284:Contract Services; D003362:Cost-Benefit Analysis; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014481:United States