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Vizient report finds behavioral health Medicaid patients under-treated compared to commercially insured patients
[May 15, 2024]

Vizient report finds behavioral health Medicaid patients under-treated compared to commercially insured patients


Vizient, Inc. today released a report showing Medicaid patients were less likely to receive the same treatment services for behavioral health as compared to commercially insured patients. While the prevalence of behavioral health conditions was roughly the same in both groups, treatment and emergency department visits among patients in each group varied. View Shining a light on disparities in mental health services.

The report, published by the Vizient Research Institute, examined claims data for 12 million covered lives across 14 states. It divided patients 0-34 into four cohorts by gender and adult status, across five diagnoses: adjustment, anxiety and personality, bipolar, persistent- and episodic-mood disorders.

"The results of this study demonstrate differences in access to care by payer," said Erika Johnson, vice president, strategic research, Vizient. "The data shows that for both adult and pediatric populations with the same behavioral health diagnosis, Medicaid patients were at least two times more likely than commercially insured patients to receive only pharmaceuticals and no psychotherapy to manage their condition."

For example, 14% of Medicaid-insured females 0-17 who were diagnosed with anxiety and personality disorders were treated with pharmaceuticals without psychotherapy, compared to 6% of commercially insured patients. For the same cohort, 66% of commercially insured patients were treated with psychotherapy with or without pharmaceuticals, whereas the same was true for only 50% of Medicaid-insured patients.

For males 8-34 diagnosed with persistent mood disorders, 24% of Medicaid patients received pharmaceuticals alone, whereas only 11% of commercially insured patients received just pharmaceuticals. For the same cohort, 67% of commercially insured patients received psychotherapy with or without pharmaceuticals, whereas 53% of Medicaid patients received psychotherapy alone.



In addition, the report found variation in access and inadequate treatment of behavioral health conditions can lead to higher utilization of the emergency department (ED). Data from the Vizient Clinical Data Base show the number of behavioral health ED visits for adult and pediatric Medicaid patients was two to six times higher compared to commercial patients. Adult and pediatric Medicaid patients were also more likely to return to the ED multiple times for their behavioral health conditions.

Among the adult commercial populations who visited the ED for anxiety and personality disorders, between 10% and 12% made at least one behavioral health related return visit within one year of their initial visit whereas 17% to 22% of adult Medicaid patients with the same diagnosis had at least one return ED visit. The pediatric population showed similar results.


"Providing a fair and appropriate standard of care across all patient populations means expanding provider access for mental health services across all types of payers," Stephanie Snider, consulting director, intelligence for Vizient said. "Some hospitals are utilizing social workers, nurse practitioners and physician assistants to close the gap in care. By expanding access earlier on, patients are less likely to need to use the emergency room for care, thereby delivering better patient care and saving money for insurers at the same time."

The Vizient Research Institute conducts rigorous quantitative research with a focus on broad healthcare economic trends affecting the affordability and sustainability of our healthcare delivery system. View Shining a light on disparities in mental health services.

About Vizient, Inc.

Vizient, Inc., the nation's largest provider-driven healthcare performance improvement company, serves more than 65% of the nation's acute care providers, which includes 97% of the nation's academic medical centers, and more than 35% of the non-acute care market. Vizient provides expertise, analytics and consulting services, as well as a contract portfolio that represents $140 billion in annual purchasing volume. Vizient's solutions and services improve the delivery of high-value care by aligning cost, quality and market performance. Headquartered in Irving, Texas, Vizient has offices throughout the United States. Learn more at www.vizientinc.com.


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