Behavioral health insurance parity for federal employees.

BACKGROUND: To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical benefits beginning in January 2001. The plans were encouraged to manage care. METHODS: We compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not have benefits on a par with mental health and substance-abuse benefits (parity of mental health and substance-abuse benefits). Using a difference-in-differences analysis, we compared the claims patterns of matched pairs of FEHB and control plans by examining the rate of use, total spending, and out-of-pocket spending among users of mental health and substance-abuse services. RESULTS: The difference-in-differences analysis indicated that the observed increase in the rate of use of mental health and substance-abuse services after the implementation of the parity policy was due almost entirely to a general trend in increased use that was observed in comparison health plans as well as FEHB plans. The implementation of parity was associated with a statistically significant increase in use in one plan (+0.78 percent, P<0.05) a significant decrease in use in one plan (-0.96 percent, P<0.05), and no significant difference in use in the other five plans (range, -0.38 percent to +0.23 percent; P>0.05 for each comparison). For beneficiaries who used mental health and substance-abuse services, spending attributable to the implementation of parity decreased significantly for three plans (range, -201.99 dollars to -68.97 dollars; P<0.05 for each comparison) and did not change significantly for four plans (range, -42.13 dollars to +27.11 dollars; P>0.05 for each comparison). The implementation of parity was associated with significant reductions in out-of-pocket spending in five of seven plans. CONCLUSIONS: When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.

Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders.

This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using DSM-IV criteria). The baseline interview documented mental illness and substance use in the past year, mental illness and substance abuse severity, demographics, service utilization in the past three months, general health and HIV-related conditions, self-reported spirituality and self-reported ARV medication use. Among the participants, 62% were prescribed ARVs at baseline (n = 542) and 45% of those on ARVs reported skipping medications in the past three days. Reports of non-adherence were significantly associated with having a detectable viral load (p<.01). The factors associated with non-adherence were current drug and alcohol abuse, increased psychological distress, less attendance at medical appointments, non-adherence to psychiatric medications and lower self-reported spirituality. Increased psychological distress was significantly associated with non-adherence, independent of substance abuse (p<.05). The data suggest that both mental illness and substance use must be addressed in HIV-infected adults living with these co-morbid illnesses to improve adherence to ARVs.

Psychotropic medication use and clinical outcomes among children and adolescents receiving system of care services.

OBJECTIVE: Few studies of psychotropic medication use among children and adolescents address the effectiveness of this medication, as it is typically used in naturalistic treatment settings. The objective of this study was to investigate psychotropic medication use among children and adolescents treated in system of care communities, to identify subject characteristics associated with psychotropic medication use, and determine whether psychotropic medication use is associated with reduced symptom severity. METHODS: Data were collected through the National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. For this evaluation, 27 system of care communities reported data on medication use and clinical ratings at intake and 6-month follow-up on children and adolescents 6-18 years of age receiving mental health services between 2006 and 2009. We used mixed-effects logistic regression to determine associations between patient characteristics and medication use, and mixed-effects linear regression to determine whether subjects taking medication and those not taking medication experienced different changes in symptom severity between intake and 6 months. RESULTS: Subject characteristics associated with psychotropic medication use, when controlling for other characteristics, included having more severe emotional and behavioral symptoms at intake, having more co-occurring diagnoses, and receiving more than one type of service. Those both taking and not taking medication showed symptom reduction at 6 months, although symptom severity among subjects taking medication remained in the clinical range. When controlling for covariates, symptom reduction was associated with medication use. CONCLUSION: Taking psychotropic medication was more strongly associated with measures of illness severity-greater symptom severity at intake, more co-occurring diagnoses, and more service intensity-than with other demographic characteristics. Subjects who took medication showed more symptom reduction at 6 months than those not taking medication, although this reduction was not sufficient to normalize symptoms among those taking medication.