FAIR Health findings on behavioral health trends

Last month, FAIR Health, an independent nonprofit that collects data for and manages the nation’s largest database of privately billed health insurance claims, released a white paper detailing national behavioral health trends. The paper takes a look at behavioral health trends from 2007 to 2017 and seeks to determine if the passage of laws, like the Mental Health Parity Act, have increased access to mental health care.


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Here are some of the main findings:

Claim lines with behavioral health diagnoses increased by a total of 108 percent during the ten-year time period. Generalized anxiety disorder was at the top of that list, increasing from 12 to 22 percent –a 217 percent increase overall. This data suggests that there is a definite increase in the number of diagnosis of behavioral health disorders. It is likely, according to the paper, that this increase in prevalence is a result of an expansion of services, and therefore, the ability to diagnose and treat a greater number of patients.

Before the passage of the Mental Health Parity Act, insurance companies covered behavioral health claims in much lower numbers, and imposed less favorable benefit limitations on behavioral health services compared to medical and surgical benefits. The passage of the act increased access to covered mental health treatment and the ACA expanded access further, requiring small and individual plans to cover services.

These changes had, according to the data herein, notable results on the number of total claims for behavioral health services.

Young adults, aged 0 to 22 had the largest increase in behavioral health claims. Generalized anxiety disorder claims among high school and college aged students increased dramatically, by 441 percent overall. The ACA allowed young adults to stay on their parents insurance until age 26, likely resulting in an increase in access to mental health services.  

Opioid dependence surpassed alcohol dependence with the largest number of claims for substance abuse disorders from 2007 to 2017. Importantly, while overall opioid claims increased, they experienced a sharp decrease of 50 percent between 2015 and 2017, likely a result of the increased policy engagement to address the issue.

Individual states showed spikes in total claims with adjustment disorder diagnosis as well. In 2007, Wyoming, Nebraska, Washington, Montana, and New Mexico had the largest claims overall. By 2017, states including Oregon, California, Nevada, Arizona, Wyoming, Maine, Iowa, Alaska, and Hawaii all showed adjustment disorder as a large percentage of all claim lines.

Maps detailing these changes are available here.

State differences with generalized anxiety disorder showed a similar trend. In 2007 the states with the largest prevalence of claim lines were Washington D.C., New York, Rhode Island, Massachusetts, and North Dakota. In 2017 this number had increased to include: Rhode Island, Washington, DC, New York, Oregon, and Minnesota. Several states had increased claims for anxiety disorder.

The passage of laws like the ACA and the Mental Health Parity Act have overall increased the number of claims across the US, and in individual states. These increases are likely a result of expanding access to care, according to the paper.

“In a time of change in the nation’s behavioral health, the trends and patterns revealed in this study have implications for numerous stakeholders, including providers, payers, researchers, policy makers and patients,” the paper explains in conclusion.

Similarly, the increased policy focus in individual states on behavioral health and substance abuse disorder is likely to increase access to care as well.