Monday, April 1, 2019

BCBSA Data Analytics Reveal Shifts in Behavioral, Mental Health

Behavioral and mental health diagnoses are on the rise for adults and children, data analytics from BCBSA indicate.  
March 28, 2019 - The nation’s behavioral and mental health patterns are changing rapidly as patients and providers change their responses to issues such as depression, ADHD, and pain management, reveals large-scale data analytics from the Blue Cross Blue Shield Association (BCBSA).
In a series of data briefs building off the 25th annual Health of America Report, BCBSA explored critical population health trends such as opioid prescribing rates, the treatment of major depression, and the management of attention disorders in pediatric patients.
Major depression is an increasingly common diagnosis among commercially insured adults, teens, and children, the payer organization notes.  More than 9 million commercially insured people have been diagnosed with depression, representing a 33 percent rise since 2013.
Diagnoses for younger people, including teenagers and millennials, are rising faster than ever before.  The rates of diagnoses for teenagers has increased by 63 percent and 47 percent for millennials.
While most Americans consider depression a serious condition that requires treatment, not everyone with a depression diagnoses is seeking out help.
More than two million individuals are not receiving any type of treatment for the challenging mental health condition, BCBSA says.  Twenty percent of the teenagers and millennials diagnosed with depression are not seeking care.
This is a significant concern for healthcare providers and payers, especially since depression is rarely found in isolation.  Eighty-five percent of individuals with depression also have another chronic disease, such as hypertension, diabetes, or substance abuse disorders.
Depression can make it much more difficult for patients to effectively manage their comorbidities, and may decrease both the duration and quality of life for affected individuals.
“As more Americans, especially millennials and adolescents, are diagnosed with major depression each year, it’s increasingly important that there’s continued research and resources allocated towards new ways to treat depression,” said Vincent G. Nelson, MD, vice president of medical affairs at BCBSA.
“The more options there are, the greater the likelihood is that we can find the right course of treatment for each person suffering from major depression.”
BCBSA suggests that providers explore how to integrate mental healthcare into the primary care environment through strategies such as colocation. 
Adding mental health counselors, psychiatrics, or other behavioral health experts to the medical home environment can reduce emergency department visits and increase the number of patients with standardized mental health management plans, the Association says.
On the other hand, some common behavioral health concerns may be overtreated, indicates a separate report based on the same large-scale population health data.
The number of children diagnosed with ADHD has also risen dramatically, nearly 2.4 million pediatric patients now diagnosed with the disorder.  That represents a 31 percent increase between 2010 and 2017, BCBSA says.
“Attention deficit hyperactivity disorder is the second most impactful condition affecting children’s health in the US,” said BCBSA. “It accounts for 16 percent of the impact all health conditions have on Generation Z (0-19 years old) as measured by the Blue Cross Blue Shield Health Index.”
Diagnoses are most common among middle schoolers, with boys receiving the label almost twice as often as girls. 
“Through these findings, we're seeing a change in what was traditionally understood amongst the medical community, which is that ADHD diagnoses are actually more prevalent among middle school children, not elementary school,” said Nelson in a separate press release.
Diagnoses rates also vary widely by geographic region, the analytics revealed.  Children in the south are more likely than those in the western states to be diagnosed, with nearly a three-fold difference between the highest and lowest states.
ADHD rates across the United States
Source: BCBSA
The data suggests that providers may be in need of more standardized best practices for diagnosing children with the behavioral health condition. 
Many children are still on medication-only treatment plans, for example, which is no longer recommended practice.  Experts now believe that a combination of medication and behavioral therapy is more effective.
“The data also revealed higher diagnosis rates in the south and that region of the US has a larger portion of children treated with medication only,” said Nelson. “Knowing this information, we're focused on ways we can provide greater access to therapists and behavioral health experts to change this trend.”
ADHD and depression are closely intertwined for many children.  About 40 percent of children with ADHD have also been diagnosed with another behavioral health disorder. 
By high school, about a quarter of children with an ADHD diagnosis will also be diagnosed with depression.  Thirty percent will also be diagnosed with anxiety.
As these children become adults, they will continue to require behavioral health treatment, especially if they develop any of the chronic diseases commonly found in conjunction with mental health concerns.
Even without an ADHD or depression diagnosis, teens and young adults are at high risk of developing another major behavioral health concern: substance use disorder.
The opioid abuse crisis continues to devastate communities across America, with scores of overdose deaths reported every day.
Preventing the development of dependence or abuse is a top concern for public health advocates, including health insurance companies that are using their financial clout to connect with patients and influence prescribing patterns among physicians.
Efforts to curb prescribing rates appear to be paying off, BCBSA’s analytics show.  The monthly rate of first-time prescriptions dropped by 54 percent between July of 2012 and December of 2017, due largely to intense national focus on the root causes of the crisis.
Nearly 30 percent of prescribers are refusing to write new prescriptions for brand new potential opioid patients, the data found – yet others are still sticking to old habits.
Some of these prescribers may feel uncomfortable restricting access to pain treatment for patients with true needs, said study lead investigator Nicole Maestas, PhD, professor of health care policy at Harvard Medical School.
“The challenge behind the opioid crisis is finding the balance between providing those who need pain relief with the necessary medicines, while also ensuring patients are not prescribed potentially dangerous doses and durations of opioids,” she said.
“The data revealed that while the health care community has made progress in curbing this epidemic, there is still a lot that needs to be done.”
Maestas worked on a collaborative team to use claims data from to better understand pain management patterns across the US.
Untreated chronic pain is also closely tied to depression, highlighting the complex interplay between different behavioral health conditions and clinical factors.
With all three conditions closely tied together, providers can use population health analytics like these to better understand changing patterns in public health and develop tailored strategies to address the unique needs of individuals.
“The research team’s findings will provide the medical and health care community with a better understanding of the impact of opioid prescriptions on first-time opioid users, providing needed insight on how we can better fight this devastating epidemic,” says Maureen Sullivan, chief strategy and innovation officer for the Blue Cross Blue Shield Association. 
“The ultimate goal is to analyze and learn about critical health issues and find meaningful solutions that improve care quality and affordability for all Americans.” 
https://healthitanalytics.com/news/bcbsa-data-analytics-reveal-shifts-in-behavioral-mental-health?eid=CXTEL000000460294&elqCampaignId=9174&elqTrackId=ab640d1433ae4738bef58b6360654826&elq=c49a4012b6ce45c996da61f1d1f47b78&elqaid=9608&elqat=1&elqCampaignId=9174

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