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Brief Summary: Mental Health and Substance Abuse Treatment in Vermont Hospital PopulationConsiderable research has demonstrated that for some conditions, early identification and targeted treatment of mental health and substance abuse disorders leads to a reduction in unnecessary or excessive medical care. These cost reductions, called cost offsets, are consistent with patterns observed in Vermont inpatient data. Specifically, the extant literature demonstrates that non-optimal treatment of anxiety, depression, and some substance abuse problems increases utilization of healthcare. This overutilization increases unnecessary costs that can be reduced by effectively treating mental health and substance abuse problems. This chapter examines patterns of hospitalization charges and explores specific conditions that are reported in the healthcare services literature as being associated with the greatest cost offsets.
In addition to information related to charges for mental health and substance abuse (MH/SA) treatment, this chapter provides an overview of the MH/SA inpatient population in Vermont. Since data suggests that elderly persons have unique needs for mental health and substance abuse treatment, diagnoses for this population are also examined. Finally, a spotlight on substance abuse highlights differences in the drug abuse profile in Vermont and the nation, as well as hospital service areas within the state.
Mental Health and Substance Abuse Outline
This chapter describes the following:
- Data source and methodology
- Who receives care for mental health and substance abuse in Vermont?
- How do Vermont hospitalizations for mental health and substance abuse compare to national data?
- Can effective mental health and substance abuse treatment reduce healthcare costs?
- How do mental health and substance abuse diagnoses differ in the elderly?
- Spotlight on substance abuse
- Summary and Conclusions
- Recommendations
For a brief summary of the findings, continue on; for a more in-depth read on mental health and substance abuse in Vermont's inpatient population, click here
Findings and Conclusions
Overall, Vermont data on patterns of treatment for mental health and substance abuse diagnoses is consistent with national data. As was the case nationally, about 20% of hospitalizations in Vermont included a primary or secondary mental health diagnosis, and about 6% of hospitalizations were for a primary mental health diagnosis[1]. Additionally, Vermont utilization rates for specific mental health disorders (as reflected in percentage of diagnoses) are generally consistent with national utilization rates.
Consistent with a large body of evidence, there is potential cost savings associated with targeted, effective treatment for mental health and substance abuse problems. Taken together, findings across five years of data are consistent with this extant research showing cost offsets for effective prevention and treatment of mental health and substance abuse disorders.2 It is clear that the greatest costs, as reflected in total charges, are associated with untreated or ineffectively treated substance abuse disorders and their related medical complications. Additionally, greater costs, as reflected in charges, associated with secondary MH/SA diagnoses, suggest that lack of identification and treatment of these problems may contribute to higher healthcare costs and utilization. In general, some secondary MH/SA diagnoses are, in part, associated with under-identification of these disorders and with lack of consistent or effective treatment for them, resulting in more severe and prolonged impairments and overutilization of healthcare.
Mental Health and the Elderly
About 35% of patients over 65 years were diagnosed with a secondary mental health or substance abuse disorder. Of this group, almost 65% were diagnosed with some history of substance abuse, which often includes complications from alcoholism. This suggests that these disorders may not be effectively identified or treated when the patient is younger or that they may worsen with age
Substance Abuse and Dependence
On average, Vermont inpatient data show that individuals with a secondary substance abuse diagnosis incurred higher total and daily charges and experienced longer lengths of stay than patients with no mental health or substance abuse diagnosis. There appears to be potential for significant reduction in healthcare cost and utilization through prevention and treatment of substance abuse and dependence.
Regional variations in hospitalization patterns for Substance Abuse and Dependence suggest that the types of substance abuse problems differ in parts of the state. Overall, Rutland, Chittenden, and Windham see the greatest hospitalization rates for substance abuse.
Recommendations
- Hospitalization data with a unique patient identifier would allow individual-level analyses. Such patient identifiers could be encrypted such that patient identity is not compromised. Unique patient identifier information will greatly enhance the types of analyses needed to inform policy decisions. These analyses should examine patterns of costs (charges), and treatment for mental health, substance abuse, medical and surgical diagnoses, and their co-morbidities. Additionally, the effect of chronic illness and multiple chronic conditions on charges and patterns of care should be included in follow-up analyses. This set of analyses will provide more complete information to inform policy related to prevention and treatment of mental health and substance abuse problems.
- The current set of analyses suggests potential cost savings and reductions in healthcare utilization might be obtained by increasing identification and evidence-based treatment for mental health and substance abuse disorders.
- Strategies for identification, prevention, treatment, and possible cost savings related to chronic problems with cannabis abuse and dependence in adults aged 45-64 should be considered.
- Needs assessment for identification, prevention, and treatment of opiod and oxycodone abuse should be conducted for targeted hospital service areas that show variation in utilization for these problems. In particular, unique social conditions leading to this utilization should be identified in order to inform policy for reducing these problems.
[1] For the purpose of readability, the term substance abuse refers to a diagnosis of either substance abuse or substance dependence. Alcohol, prescription, and illicit drugs are subsumed under the term “substance.” Findings relevant to specific drugs or categories are labeled to indicate the relevant substance or substances.
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