FAIR Health Presents on Behavioral Healthcare at AHIMA19

On September 18 in Chicago, IL, FAIR Health President Robin Gelburd presented some of our recent findings on behavioral healthcare at AHIMA19: Health Data and Information Conference, organized by the American Health Information Management Association (AHIMA). In an address entitled “Using Claims Data to Illuminate Trends and Patterns in Behavioral Healthcare,” Ms. Gelburd discussed the results, all based on analysis of data from FAIR Health’s repository of billions of private healthcare claim records, the largest in the country.

Overview of Behavioral Health
Ms. Gelburd noted that claim lines with behavioral health diagnoses (including both mental health and substance abuse and dependence) rose 108 percent as a percentage of all medical claim lines from 2007 to 2017. Claim lines with mental health diagnoses increased 86 percent and those with substance abuse and dependence 405 percent.

Mental Health Diagnoses
Major depressive disorder had the largest share of claim lines with mental health diagnoses in both 2007 (28 percent) and 2017 (26 percent), while generalized anxiety disorder jumped from the third largest share in 2007 (12 percent) to the second largest share in 2017 (22 percent).

Ms. Gelburd presented particular mental health diagnoses—adjustment disorders, major depressive disorder, generalized anxiety disorder and eating disorders—from various perspectives, including age, gender, geography, procedure and place of service.

For example, the pediatric share of the claim line distribution for major depressive disorder increased from 15 percent in 2007 to 23 percent in 2017. (“Pediatric” in this presentation included individuals from 0 to 22 years of age.) The pediatric share of claim lines for generalized anxiety disorder also increased, from 19 percent in 2007 to 24 percent in 2017.

The top procedure used in 2017 for both major depressive disorder and generalized anxiety disorder, in terms of both utilization and total costs, was CPT®1 90834, 45-minute psychotherapy with patient. For anorexia, CPT 90834 was the top procedure by utilization, but the top procedure by total costs was H0035, mental health partial hospitalization, treatment, less than 24 hours.

For 78 percent of claim lines with major depressive disorder and 84 percent of those with generalized anxiety disorder, the place of service in 2017 was an office. For anorexia, only 48 percent of claim lines had an office as the place of service.

Substance Use Disorders
Alcohol dependence had the largest share of claim lines with substance use disorder diagnoses in 2007 (30 percent), but fell to second place in the distribution in 2017 (28 percent). Opioid dependence, which was in third place in 2007 (14 percent), climbed to first place in 2017 (37 percent).

As with mental health diagnoses, Ms. Gelburd examined certain substance use disorder diagnoses—alcohol, cannabis, cocaine and opioid abuse and dependence—in the context of variables such as age, gender, geography, procedure and place of service.

Analyzing alcohol abuse and dependence by age and gender, Ms. Gelburd showed that in 2017 more claim lines were submitted for females than males in the age group 14 to 18, but in all age groups older than 18, the reverse was true: The majority were submitted for males.

In 2017, the state with the highest percentage of claim lines associated with cannabis abuse and dependence compared to claim lines for all medical diagnoses was New York, but the state with the highest percentage associated with cocaine abuse and dependence was West Virginia.

The top procedures for opioid abuse and dependence differed from state to state. For example, the top procedure by utilization in 2017 in Texas and Arizona was CPT 80307, testing for presence of drug. But in New York it was H0020, alcohol and/or drug services; methadone administration.


1. CPT © 2018 American Medical Association (AMA). All rights reserved.