FAIR Health 10-Year Study Shines Spotlight on Behavioral Health

In May, FAIR Health released a white paper on trends in the nation’s behavioral health in the decade from 2007 to 2017. Based on analysis of data from FAIR Health’s repository of more than 28 billion private healthcare claim records, the study showed disproportionate representation of young people in the increase in claims for mental health diagnoses.

Entitled Spotlight on National Behavioral Health Trends: A 10-Year Window into Key Mental Health and Substance Abuse Indicators, the white paper examined two kinds of behavioral health disorders, mental health and substance use disorders, during the period before and after the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The study quickly garnered media attention from such outlets as STAT, the Washington Post, Modern Healthcare, Becker’s Hospital Review and Crain’s New York Business. Articles by FAIR Health president Robin Gelburd on the white paper’s findings appeared in U.S. News & World Report and the American Journal of Managed Care.

These are some of the white paper’s key findings:

Increased Utilization of Behavioral Healthcare

Claim lines with behavioral health diagnoses increased 108 percent from 2007 to 2017, rising from 1.3 percent to 2.7 percent of all medical claim lines. Claim lines associated with mental health diagnoses increased 86 percent, from 1.2 percent to 2.3 percent of all medical claim lines. Claim lines associated with substance abuse and dependence diagnoses grew 405 percent, from 0.1 percent to 0.5 percent of all medical claim lines.

Increased Prevalence of Generalized Anxiety Disorder

From 2007 to 2017, claim lines for generalized anxiety disorder became much more common, rising from 12 percent to 22 percent of the distribution of mental health claim lines. Of mental health diagnoses with over 0.1 percent of all medical claim lines, generalized anxiety disorder had the greatest increase in claim lines, rising 217 percent from 0.168 percent to 0.523 percent of all medical claim lines.

Disproportionate Representation of Young People

The pediatric population, defined as ages 0-22 to include young adults of college age, was disproportionately represented in the increase in claim lines with mental health diagnoses. The pediatric share of claim lines for major depressive disorder increased from 15 percent in 2007 to 23 percent in 2017. Claim lines for individuals aged 19-22 (college age) increased in their share of the distribution for pediatric major depressive disorder, from 29 percent in 2007 to 36 percent in 2017. For generalized anxiety disorder, claim lines for individuals of college age and high school age (14-18) rose by greater percentages from 2007 to 2017 than any other group in the age range studied (6 and older).

Geographic Changes

From 2007 to 2017, claim lines for major depressive disorder and generalized anxiety disorder became more common by comparison to claim lines for all medical diagnoses by state in most parts of the country, with the exception of the South.

Substance Use Disorder Trends

From 2007 to 2017, opioid dependence overtook alcohol dependence to represent the largest share of claim lines with substance use disorder diagnoses. Yet, although opioid dependence claim lines increased overall from 2007 to 2017 (1,180 percent, growing from 0.016 percent to 0.252 percent of all medical claim lines), they fell 50 percent from 2015 to 2017 (from 0.479 percent to 0.252 percent of all medical claim lines).

FAIR Health President Robin Gelburd commented: “Our study provides a strong foundation of key indicators of behavioral health services among the privately insured. We look forward to further studies that focus on the specific services rendered, the types of venues where patients seek care and the specialties of the healthcare professionals providing the services.”