AJMC Issue Addresses Cost Control in Mental Health

Two articles in the new issue of The American Journal of Managed Care address aspects of paying for mental health care: how valued-based insurance design, a concept pioneered by AJMC’s editors, might be applied; and how the arrival of generic risperidone was received in Medicare Part D.


PLAINSBORO, N.J.—The Affordable Care Act, which affirmed the federal parity act’s call for equal access for those needing mental health care, nonetheless raises the question, “How do we pay for it?” Articles in the current issue of The American Journal of Managed Care address this issue, both broadly and in the case of a key medication.

Authors Alesia Ferguson, PhD; Christopher Yates, BA; and J. Mick Tilford, PhD; explore whether mental health care would benefit from the application of value-based insurance design (V-BID), a concept made famous by the journal’s editors, A. Mark Fendrick, MD, and Michael E. Chernew, PhD.

V-BID asks that those therapies or procedures that are most clinically valuable be provided with lower out-of-pocket costs to patients; in the case of mental health, this might apply not only to certain medications, but also to an allotment of visits with a therapist, depending on the condition.

As the authors note, V-BID in mental health presents certain challenges, especially in the workplace. Employees might not be willing to admit a substance abuse problem on a form, for example. And some will rely on primary care doctors. “Designing some incentive to be given to the physician for identifying and following up with a patient’s mental health care through an appropriate specialist could become one aspect of V-BID for mental health treatment,” they write.

While hurdles exist, the incentive for finding savings is high—federal estimates for mental health costs were $155.3 billion in 2009. Savings, however, would not just come from healthcare, but also from other government programs and beyond. “The cost savings of an effective mental health V-BID will not necessarily be realized within healthcare systems; a complete analysis must consider all welfare and social costs, which could be substantial,” the authors note.

Also in this issue, Vicki Fung, PhD, et al, examine the effects of the arrival of generic risperidone in Medicare Part D. The authors write that introducing generics is always a double-edged sword among mental health patients—changing the look or packaging of a medication can be alarming, but reducing out-of-pocket costs can improve adherence. And for Medicare, if costs are lower and adherence improves, that’s something policymakers want to hear.

Fung and her co-authors found that use of the generic medication was concentrated among those who had previously used the branded form of the drug, and that managed care plans were more effective at encouraging the switch than fee-for-service plans. Lower copayments appeared to be associated with better adherence.

About the Journals and AJMC.com

The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

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