April 1st, 2013

Study: parity provides relief for most vulnerable

We’re well aware of what “parity” – as it applies to mental health insurance coverage – is supposed to do. In a perfect world, parity mandates that insurance companies cannot differentiate between mental health benefits and traditional medical health benefits; they are to be treated equally in terms of allowable treatments, patient co-pays and benefit limits.

This result is the goal of the Mental Health Parity and Addiction Equity Act (MHPAEA), which was implemented in 2010. There are, however, a number of parameters that can influence the way benefits are administered. One of them involves the individual’s diagnosis. Specifically, how does parity affect patients with disorders of varying severity?

That question was the focus of a recent study led by Alisa B. Busch, M.D., M.S., director of integration of clinical measurement and health services research at McLean Hospital. Although this study was not the first to investigate parity’s impacts on patient benefits, it was the first to quantify the relationship between diagnoses and benefits.

The findings indicate that parity does what it’s supposed to do: provide financial relief for those with the most serious conditions.

“The whole purpose of insurance is to protect people from catastrophic financial loss,” says Busch, an assistant professor of psychiatry and health care policy at Harvard Medical School. “People with more disabling conditions are the ones who use services more often and they’re more likely to encounter benefit limits, compared to people with less severe illnesses. They will have greater financial risk.”

The study, which was published in the February American Journal of Psychiatry, did not examine the MHPAEA; there is limited documentation of its effects at this point. Instead, Busch and six colleagues analyzed the effects of an earlier program, the Federal Employees Health Benefits (FEHB) Program, which instituted a parity directive in 2001.

The FEHB provided a good model for the research because insurance data could be easily obtained and a sizeable control group of privately-insured enrollees (not affected by the parity program) was also available. Data from 2000 and 2002, before and after parity, was analyzed to determine the amount of treatment utilized by patients as well their spending and out-of-pocket costs. The total number of cases studied was nearly 30,000.

The information was further broken down by three diagnostic groups: bipolar disorder, major depression and adjustment disorder.

“They’re along a continuum, on average, of severity and chronicity, with bipolar disorder, on average, being the most severe and chronic,” explains Busch. “We wanted to understand the impact of parity and find out if the diagnosis mattered. That had not been done before.”

The diagnosis did matter. Individuals being treated for bipolar disorder did not see a decrease in services but reduced their average annual out-of-pocket spending by $148. Similarly, patients with major depression also maintained their level of service and also reduced their annual out-of-pocket spending by an average $100.

Spending by individuals treated for adjustment disorder also declined, but so did the level of service. These patients had 12 percent fewer psychotherapy sessions.

Although the results of this study are proving valuable, Busch concedes that more research is warranted. For pragmatic reasons, the research did not include examination of treatment outcomes.

“Studying treatment outcomes is a really important next step in our understanding of the impact of parity,” says Busch, who notes that investigator groups are now looking at the effects of the new federal parity law.

“In any area of research and science, you want to see multiple studies approach a topic in complementary ways. You’re looking for an overall body of evidence to understand the impact,” she says.

By Howard Newman

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