Abstract
BackgroundThe objective of this study was to investigate factors associated with substance use disorder identification and follow-up rates among samples of members of a private health insurance plan.MethodsIn an observational study, samples of claims data for 2017 for Commercial and Medicare members from a private health insurer were accessed and analyzed using descriptive statistics, decision tree analysis, and linear regression models.ResultsCommercial and Medicare members differed in age. Medicare members had higher rates of inclusion in a measure of substance use disorder than Commercial members, lower rates of initial short term follow-up, more opioid prescriptions from primary care provides, fewer prescriptions for opioid treatment, and higher rates of selected comorbid conditions. Mental health diagnoses and substance use disorder co-occurred frequently and to a greater extent in the Medicare sample. Among commercial members, there were primarily alcohol problems that increased with age, while opioid problems at about 10% peaked in the mid-twenties. More males were included among all substance types. The overall rate for an initial short term follow-up visit indicating initiation of treatment was 30%. There were large differences in the follow-up rates across settings with a very low rate (4.6% for alcohol and 6.9% for opioid) in primary care settings.ConclusionsThese results suggest that increased attention in primary care to young adult males and to older adults, may help to reduce substance use disorder rates, especially alcohol use disorders.
Highlights
The objective of this study was to investigate factors associated with substance use disorder identification and follow-up rates among samples of members of a private health insurance plan
Commercial and Medicare members Our sample of Commercial members for 2017 included 347,471 individuals compared to 43,174 members for the Medicare sample
The number of members in the primary SUD sample meeting the criteria for a substance use disorder was larger (n = 3494 vs. n = 1152)
Summary
The objective of this study was to investigate factors associated with substance use disorder identification and follow-up rates among samples of members of a private health insurance plan. Alcohol use disorder and dependence continues to lead to chronic health problems and other adverse consequences, while addiction to opioid drugs has reached epidemic proportions. Health insurers play an important role in understanding these problems and intervening with their members to manage and reduce the ill effects of substance use disorder. A recent study found an association between behavioral health conditions and behavioral health medications and both initial and long term opioid prescriptions among patients with commercial health insurance (e.g., cox regression hazard ratios of 1.94 (CI: 1.91–1.96) for depression and 1.71 (CI: 1.69–1.73) for depression medication) [2]. Behavioral health treatment for depression during residential substance use disorder treatment has been shown to be cost effective (incremental cost effectiveness ratio of $131 per each point improvement on the Beck Depression Inventory-II and $49 for each depression free day) [3]
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