Online Program

Benefit design implications for claims data missingness (306619)

Keywords: mental health services, psychiatry, medications, provider networks, insurance design

Health insurance is meant to assist members in accessing needed care, but plans are rarely comprehensive. Researchers examining mental health care confront particular complexities and must exercise caution when assessing results. Lack of integration with primary care and commonplace carve-out arrangements are threats to claims-based studies. Our research also found that even where mental health services are covered, people often obtain care entirely outside of insurance because of provider shortage, provider network inadequacy, providers refusing participation in insurance, and highs barriers to out-of-network care. The potential availability of external mental health services with external financing (e.g., based in the community, schools, or Employee Assistance Programs) further limits the capture of mental health utilization, costs, and clinical information by claims data. Separately, the use of uncovered or high cost medications may be missing when patients use pharmaceutical patient assistance programs (e.g., coupons). Mixed methods research offers avenues for better understanding these forms of missingness.