Hawrilenko Matt, Smolka Casey, Ward Emily, Ambwani Geetu, Brown Millard, Mohandas Anita, Paulus Martin, Krystal John, Chekroud Adam
Spring Health, New York, New York.
Laureate Institute for Brain Research, Tulsa, Oklahoma.
JAMA Netw Open. 2025 Feb 3;8(2):e2457834. doi: 10.1001/jamanetworkopen.2024.57834.
Employer-sponsored benefit programs aim to increase access to behavioral health care, which may help contain health care costs. However, research has either focused solely on clinical outcomes or demonstrated reductions in medical claims without accounting for the costs of behavioral health services, leaving the financial return on investment unknown.
To determine whether a clinically effective employer-sponsored behavioral health benefit is associated with net medical cost savings.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included participants eligible for an employer-sponsored behavioral health benefit between November 1, 2019, and May 31, 2023. Eligibility criteria included having a behavioral health diagnosis and, in the program group, attending at least 1 behavioral health appointment. Program users were matched to nonusers on medical risk scores, behavioral health diagnoses, date of diagnosis, age, sex, and employer. Participants were followed up for 1 year before and after the benefit launch.
A digital platform screened individuals for common behavioral health conditions and provided access to video and in-person psychotherapy, medication management, care navigation, and self-guided digital content.
Primary outcomes were per member per month (PMPM) medical spending, inclusive of all medical claims and program costs. A difference-in-differences analysis was used to compare changes in net medical spending between groups from the year before and up to 1 year after an index mental health diagnosis.
This study included 13 990 participants: 4907 of 4949 (99.1%) eligible program group members were matched to 9083 control participants. Their mean (SD) age was 37 (13.2) years, and most participants (65.5%) were female. Costs decreased in the program group relative to the control group, with a net difference-in-differences of -$164 PMPM (95% CI, -$228 to -$100 PMPM), corresponding to savings of $1070 per participant in the first program year and a return on investment of 1.9 times the costs (ie, every $100 invested reduced medical claims costs by $190). Behavioral health costs in the program group increased relative to the control group but were more than offset by decreases in physical health care costs. Savings were larger for participants with higher medical risk.
In this cohort study, every $100 invested in an employer-sponsored behavioral health program with fast access to psychotherapy and medication management was associated with a reduction in medical claims costs by $190. These findings suggest that expanding access to behavioral health care may be a financially viable cost-reduction strategy for health care buyers.
雇主赞助的福利计划旨在增加获得行为健康护理的机会，这可能有助于控制医疗保健成本。然而，研究要么仅关注临床结果，要么证明医疗索赔有所减少，但未考虑行为健康服务的成本，使得投资的财务回报不明。
确定临床上有效的雇主赞助行为健康福利是否与医疗成本净节省相关。
设计、设置和参与者：这项回顾性队列研究纳入了2019年11月1日至2023年5月31日期间有资格享受雇主赞助行为健康福利的参与者。资格标准包括有行为健康诊断，且在计划组中至少参加1次行为健康预约。计划使用者根据医疗风险评分、行为健康诊断、诊断日期、年龄、性别和雇主与非使用者进行匹配。在福利推出前后对参与者进行了1年的随访。
一个数字平台对个体进行常见行为健康状况筛查，并提供视频和面对面心理治疗、药物管理、护理导航以及自助式数字内容。
主要结局是每位成员每月（PMPM）的医疗支出，包括所有医疗索赔和计划成本。采用差异-in-差异分析来比较从心理健康诊断前一年到诊断后长达1年期间两组净医疗支出的变化。
本研究纳入了13990名参与者：4949名符合条件的计划组成员中有4907名（99.1%）与9083名对照参与者进行了匹配。他们的平均（标准差）年龄为37（13.2）岁，大多数参与者（65.5%）为女性。与对照组相比，计划组的成本有所下降，PMPM净差异-in-差异为-$164（95%CI，-$228至-$100），相当于第一个计划年度每位参与者节省1070美元，投资回报率为成本的1.9倍（即每投资100美元可减少医疗索赔成本190美元）。计划组的行为健康成本相对于对照组有所增加，但被身体健康护理成本的下降所抵消。医疗风险较高的参与者节省的费用更多。
在这项队列研究中，每投资100美元用于雇主赞助的行为健康计划，快速获得心理治疗和药物管理，可使医疗索赔成本降低190美元。这些发现表明，扩大行为健康护理的可及性可能是医疗保健购买者在经济上可行的成本降低策略。
