Mental and behavioral health has been coming to the forefront as both an under-diagnosed and under-treated condition affecting employer workforces and health plans. The problem is so profound, yet so poorly understood to the point that many are coming up with theories about where these problems lie and what can be done to address them.
Interactive Health, a national wellness vendor, recently published a paper claiming that younger employees were more likely to suffer from mental and behavioral health issues. Is this really an issue for the young, or something that impacts the entire workforce equally?
The data analytics team at AP Benefit Advisors decided to take a look. Comparing younger and older employee populations’ utilization of mental and behavioral health services, using data from our book of business from May 2015 to April 2018, yielded interesting results. Our research is based on reported medical and pharmacy claims and does not account for un-diagnosed conditions. We relied on treatment data from licensed and certified medical practitioners as opposed to self-reporting, or other less reliable sources.
Two samples of employees were studied, one including workers between 17 and 35 years of age, and the other including workers between 36-66 years of age.
Looking at claims for mood and anxiety orders, we discovered that 5.33% of the younger population incurred these types of claims. Younger workers with these diagnoses yielded an average annual claims cost of roughly $2,170.
In the other bucket, 5.39% of the employees aged 36-66 incurred claims for mood and anxiety disorders. That’s nearly identical prevalence compared to the younger employees. Additionally, those employee’s annual claims averaged roughly $2,050 per person, a 4% difference than the younger employees.
Another major factor in determining the clinical cost impact these conditions are having on employer health plans was breaking down the prescription utilization by drug class.
The four relevant drug classes that were studied, that also had enough credible claims data, were Attention Deficit-Hyperactive Disorder (ADHD) therapy, antidepressants, antipsychotics, and chemical dependency agents.
According to the data, prescription cost per employee per month (PEPM) for ADHD therapy was double in the younger population than the older population. Regarding antidepressants, the older population spent 32% more PEPM than the younger employees. The antidepressant class had the greatest total cost for employees aged 36-66.
Comparing pain control and substance abuse claims is also an effective way to see the impact these behavioral conditions, which include opioid abuse, have on health plans. The condition analyzed was the use of opioid at high dosage in persons without cancer. Employees of the ages between 36 and 66 had triple the incidence of high opioid use, with 3.1% of the population flagged for this condition, as workers age 17-35 (0.9%).
The results of the above analysis are simple – mood and anxiety disorders, especially on an aggregate scale, are not a new or trendy condition with which only younger adults struggle. These disorders do not discriminate against age in terms of incidence and total cost. And while we might be able to obtain simple generalizations about ADHD and Depression medications, we really cannot reach any conclusions about the impacts mental and behavioral health conditions have on an employee population by simply looking at a census.
Mental health, behavioral health, depression, anxiety and mood disorders are problems that need greater exposure and more members seeking treatment. However, we must acknowledge that these conditions affect every individual differently, with equal severity in any given population. Making any other assumptions could be doing a great disservice to your plans and its members.
