To help policymakers and interested parties better understand how consumers use mental health services and the cost of those services, the Office of the Insurance Commissioner (OIC) contracted with Onpoint Health Data to create a searchable dashboard of behavioral health-specific claims. The data is from the Washington All Payer Claims Database (WA-APCD) and includes claims between 2017 -2022 for all state-regulated health plans and Washington’s Public and School Employee Health Benefit Programs (PEBB/SEBB).
The information in the dashboard will be available to policy experts, legislators and others to get a better understanding of how mental health care services are accessed across Washington state and to propose solutions that improve access and coverage for these critical services.
Anyone can use the dashboard to find:
- How often consumers sought treatment for various mental health conditions.
- The types of services used.
- How often out-of-network providers were used and how that varied across the state.
- How much insurers paid providers for these services.
Key findings include:
- From 2017-2022, the percentage of insurance claims involving a mental health diagnosis increased from 11.83% to 17.43%.
- In 2022, 18% of enrollees in an urban area had a mental health diagnosis compared to 13.55% in rural areas.
- In 2022, 7.6% of mental health services were provided by out-of-network providers compared to 4.2% of other medical services.
- The cost of mental health services has increased 69% since 2017, driven primarily by the use of services. During the same time, the average amount paid to providers per service has only increased by 4%.
How to use the dashboard
You can do four types of searches:
- Cost Driver - Search by the type of mental or medical health service for all health plan enrollees, enrollees with any mental health illness or enrollees with a serious mental health condition.
- Conditions Overview - Search by year, mental health condition and diagnosis for various measurements including outpatient facility rate, hospital emergency department visit rate, pharmacy claims and more.
- Geographical Overview – Search mental health conditions and diagnosis by region for various services, such as rates of pharmacy claims, primary care visits and inpatient admission rates.
- Network Analysis – See the types of claims by year and region that were provided either by network or out of network providers.
Example: Find out what’s driving the cost of psychotherapy counseling.
Steps:
- Select the “Cost Drivers” tab.
- Select “Psychotherapy/Counseling” from the “Service Type” dropdown menu.
- Select “All Members” from the “Member Population” dropdown menu.
Results:
According to the data, use, not price, drove the per member per month increase:
- Per member per month (PMPM) cost increased 112%.
- Use per 1,000 members increased by 94%.
- The average price per service increased by 9%.
Project funding
This project was supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $684,447 with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.