Stephanie K Doupnik1, Jonathan Rodean2, James Feinstein3, James C Gay4, Julia Simmons5, Jessica L Bettenhausen5, Jessica L Markham5, Matt Hall2, Bonnie T Zima6, Jay G Berry7. 1. Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, The Leonard Davis Institute of Health Economics, The University of Pennsylvania (SK Doupnik), Philadelphia, Pa. Electronic address: DoupnikS@chop.edu. 2. Children's Hospital Association (J Rodean and M Hall), Washington, DC. 3. Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children's Hospital Colorado, University of Colorado School of Medicine (J Feinstein), Aurora, Colo. 4. Department of Pediatrics, Monroe Carell Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine (JC Gay), Nashville, Tenn. 5. Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine (J Simmons, JL Bettenhausen, and JL Markham), Kansas City, Mo. 6. Department of Psychiatry and Biobehavioral Sciences, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (BT Zima). 7. Division of General Pediatrics, Department of Medicine, Complex Care Service, Boston Children's Hospital, Harvard Medical School (JG Berry), Boston, Mass.
Abstract
OBJECTIVE: To examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups. METHODS: This retrospective analysis utilized 2016 Medicaid claims from 11 states and included 775,945 children ages 3 to 17 years with any MH diagnosis and at least 11 months of continuous coverage. We compared demographic characteristics and Medicaid expenditures based on total health care spending: the top 1% (highest-spending) and remaining 99% (typical-spending). We used chi-squared tests to compare the 2 groups and adjusted logistic regression to identify independent predictors of being in the top 1% highest-spending group. RESULTS: Children with MH conditions accounted for 55% of Medicaid spending among 3- to 17-year olds. Patients in the highest-spending group were more likely to be older, have multiple MH conditions, and have complex chronic physical health conditions (P <.001). The highest-spending group had $164,003 per-member-per-year (PMPY) in total health care spending, compared to $6097 PMPY in the typical-spending group. Ambulatory MH services contributed the largest proportion (40%) of expenditures ($2455 PMPY) in the typical-spending group; general health hospitalizations contributed the largest proportion (36%) of expenditures ($58,363 PMPY) in the highest-spending group. CONCLUSIONS: Among children with MH conditions, mental and physical health comorbidities were common and spending for general health care outpaced spending for MH care. Future research and quality initiatives should focus on integrating MH and physical health care services and investigate whether current spending on MH services supports high-quality MH care.
OBJECTIVE: To examine how characteristics vary between children with any mental health (MH) diagnosis who have typical spending and the highest spending; to identify independent predictors of highest spending; and to examine drivers of spending groups. METHODS: This retrospective analysis utilized 2016 Medicaid claims from 11 states and included 775,945 children ages 3 to 17 years with any MH diagnosis and at least 11 months of continuous coverage. We compared demographic characteristics and Medicaid expenditures based on total health care spending: the top 1% (highest-spending) and remaining 99% (typical-spending). We used chi-squared tests to compare the 2 groups and adjusted logistic regression to identify independent predictors of being in the top 1% highest-spending group. RESULTS:Children with MH conditions accounted for 55% of Medicaid spending among 3- to 17-year olds. Patients in the highest-spending group were more likely to be older, have multiple MH conditions, and have complex chronic physical health conditions (P <.001). The highest-spending group had $164,003 per-member-per-year (PMPY) in total health care spending, compared to $6097 PMPY in the typical-spending group. Ambulatory MH services contributed the largest proportion (40%) of expenditures ($2455 PMPY) in the typical-spending group; general health hospitalizations contributed the largest proportion (36%) of expenditures ($58,363 PMPY) in the highest-spending group. CONCLUSIONS: Among children with MH conditions, mental and physical health comorbidities were common and spending for general health care outpaced spending for MH care. Future research and quality initiatives should focus on integrating MH and physical health care services and investigate whether current spending on MH services supports high-quality MH care.
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