FAIR Health study: claims, diagnoses increase

By Susan Gonsalves
June 30th, 2024
Robin Gelburd is President at FAIR Health Inc.
Robin Gelburd is President at FAIR Health Inc.

Fewer patients seek help from psychologists

Patients with mental health diagnoses rose nearly 40%, from 13.5% who received medical services in 2019 to 18.9% in 2023, according to a study released in April by FAIR Health.

The study, entitled, “Trends in Mental Health Conditions,” looked at data across geography, age, gender, in-network services, substance use with mental health and more.

Claim lines associated with mental health diagnoses grew in all states nationally from 3.8% of medical claims to 5.0% during that time-period. The smallest growth came in states including Massachusetts and Maine with Connecticut among the states with the largest growth.

“We leave it to healthcare stakeholders—including psychologists and other mental health professionals—to draw out other implications for their work.” -- Robin Gelburd, J.D., president, FAIR Health

(A claim line is an individual service or procedure listed on an insurance claim.)

Robin Gelburd, JD, the organization’s president, questioned whether the increasing availability of mental health services through telehealth “party explains this change.”

The sharpest rise of in-network claims associated with mental health occurred in the last quarter of 2023.

Gelburd said a somewhat surprising result was that the largest increase in the percentage of patients with mental health diagnoses was in the 65 and older age range, with a jump of 57.4%.

However, those with ages 18-25 had the highest prevalence of mental illness at 33.7%, followed next by ages 26-49 (28.1%).

Although there were increases across all mental health disorders, the most common diagnoses in 2023 was generalized anxiety disorder. However, among patients ages up to 13, ADHD was the most prevalent condition.

Following GAD the most common diagnoses overall were major depressive disorder, attention-deficit/hyperactivity disorder, adjustment disorders and bipolar disorder. The largest increase (70.4%) was for patients with ADHD, which rose from fourth most common mental health diagnosis in 2019 (1.8% of patients) to third most common in 2023 (3.1%).

Regional increases in mental health conditions ranged from the Northeast at 36.3% to 47.0% in the Midwest. In addition to the largest increase, the Midwest has the highest number of diagnoses (21.3%).

The impact of the pandemic was mentioned, noting a global increase in major depressive disorder (27.6%) and anxiety (25.6%). Commercially insured adults use rate for mental health grew 38.8% from 2019 to 2022.

The sharpest rises in telehealth claims took place in the first quarter of 2020 and the fourth quarter of 2023. Regarding the places of service for mental health between 2019 to 2023, offices decreased by 39.8% while telehealth increased by 5,123.4%.

Data also indicated non-physician specialists increasing their share of mental health diagnoses. These specialists include social workers, psychiatric nurses, nurse practitioners, and physician’s assistants.

Conversely, psychologists acting as treating specialists decreased by 27.1%, while psychiatrists declined by 26.4%.

Gelburd said this result may just reflect on more reliance of other specialists and declined to speculate on “the reasons behind these trends.”

She said, “Instead, we seek to offer insights with respect to mental healthcare services drawn from our rich claims collection that could help fuel other researchers to dig more deeply into causal factors.”

Other findings showed:

-Of mental health patients, 15.7% also had a substance use disorder and only 5.6% of people without a mental health condition had a substance use disorder;

-Diagnoses among females rose by 44.6% compared to men at 32.7%;

-The number of young people reporting persistent feelings of sadness and hopelessness increased by 50%, with 28% reporting these feelings in 2011 to 42% in 2021; and

-Barriers to treatment cited were staff shortages, social stigma, racial and ethnic issues, lack of education/awareness, and a substantial proportion of psychiatrists do not accept insurance.

Gelburd added that FAIR Health does not suggest specific uses for the study’s findings, but said they may help inform intake questionnaires for patients.

As for other studies, Gelburd noted, We are always seeking ways to use our data as the basis for timely and relevant research reports as well as to revisit and/or update prior studies.”

Information for this report was collected from claims data from privately insured patients and third-party administrators who voluntarily participated, (excluding Medicaid, CHIP and other state/local government programs).

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