Using the Medical Expenditure Panel Survey to Explore the Association Between High Healthcare Utilization and Behavioral Health Diagnoses in a Pediatric Population with Chronic Conditions

The 2010 Affordable Care Act (ACA) introduced an era of changing healthcare delivery and utilization, which is still evolving and changing to this day. Healthcare providers and healthcare systems need to identify strategies to provide better care to patients, that results in better patient outcomes, in a cost effective way. One strategy to accomplish this goal is to focus on managing the care of the most vulnerable patients, particularly including pediatric patients with one or more chronic conditions. The objective of this study was to assess the extent to which a behavioral health diagnosis in addition to another chronic condition impacted patterns of healthcare utilization for pediatric patients in order to identify the most at-risk patient populations and propose care management strategies specific to the needs of these patients. Data from the Medical Expenditure Panel Survey (MEPS) from 2007-2016 was used to evaluate the cost of care and healthcare utilization, and conduct logistic regression analysis to study utilization patterns. Using a weighted sample of 741 million children over a ten-year span, the study found that children with behavioral health diagnoses had mean total health care expenditures approximately double that of children without behavioral health diagnoses. Children with behavioral health diagnoses had more than three times the mean number of prescription medications as children without behavioral health diagnoses. Children with behavioral health diagnoses and asthma, and children with behavioral health diagnoses and diabetes, had higher total expenditures and visits compared to children without either diagnosis, or with only one. Children without a behavioral health diagnosis and with a gastrointestinal disorder, had higher total healthcare expenditures than children with both diagnoses, or children with a behavioral health diagnosis alone, but otherwise children with a behavioral health diagnosis and a gastrointestinal disorder shared the same patterns as other patient sub-populations. Odds ratios were calculated to determine the odds of disease diagnosis and healthcare utilization outcomes. Children with behavioral health diagnoses were found to have 3.47 (CI 2.79-4.32) times greater likelihood of having any total healthcare expenditures compared to children without a behavioral health diagnosis. They were also more likely to have office based expenditures (OR 2.59, CI 2.32-2.9) and prescription medication expenditures (OR 3.34, CI 3.01-3.7) than children without a behavioral health diagnosis. Healthcare utilization was also analyzed based on children being in the top 10th percentile of healthcare use. Children in the top 10th percentile of total healthcare utilization had higher odds of having asthma, for those with (OR 4.2, CI 2.6-6.8) and without (OR 3.5, CI 2.9-4.2) a behavioral health diagnosis. Children in the top 10th percentile with (OR 20.8, CI 2.5-175.4) and without (OR 44.8, CI 13.9-144.3) a BH diagnosis had higher odds of having diabetes. Children in the top 10th percentile with a BH (OR 3.3, CI 1.5-7.2) diagnosis and without (OR 2.8, 2.3-3.5) a BH diagnosis had slightly higher odds of having a GI diagnosis compared to children in other percentiles. This study found that having a behavioral health diagnosis and a chronic condition did make it more likely that a patient would have higher patterns of healthcare utilization both in terms of total expenditures and in terms of number of encounters with the healthcare system. The study suggests that identifying vulnerable patient populations can be a valuable tool in providing patient care management, and in determining the best ways to provide care for the unique needs of patients with behavioral health and chronic conditions