title: The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among "carve-out" enrollees.
abstract: Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008 to 2013 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-2013) periods. The sample included 1,812,541 individuals ages 27-64 (49,968,367 person-months) in 10,010 Optum "carve-out" plans. Two-part regression models with Generalized Estimating Equations were used to estimate expenditures by payer and outpatient, intermediate and inpatient service use. We found little evidence that MHPAEA increased utilization significantly, but somewhat more robust evidence that costs shifted from patients to plans. Thus the primary impact of MHPAEA among carve-out enrollees may have been a reduction in patient financial burden.
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA. Electronic address: settner@mednet.ucla.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: M Harwood
authors.affiliation: Optum®, United Health Group, Minnetonka, MN, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Thalmayer
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Ong
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Haiyong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Optum®, United Health Group, Minnetonka, MN, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bresolin
authors.affiliation: Department of Psychiatry, Neuropsychiatric Institute, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.affiliation: Optum®, United Health Group, Minnetonka, MN, USA.
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
mesh_terms: D000328:Adult; D005260:Female; D005102:Health Expenditures; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D011570:Psychiatry; D014481:United States
keywords: Behavioral health; Expenditures; Insurance benefits; Parity; Utilization