Newest report in Trilliant Health’s “Trends Shaping the Health Economy” series found an 18% surge in behavioral health visit volume, resulting in rising rates of comorbidities and increased overall spending.

Americans under 18 are experiencing higher diagnosis rates of select behavioral health conditions, including a 107% rise in eating disorder diagnoses.

Patients visiting the ED for behavioral health issues are not receiving appropriate follow-up care; one in 10 patients with alcohol or substance use disorder who visit the ED will return within 30 days.

Prescribing for mental health rises across all drug categories.

March 08, 2023 (Nashville, Tenn.) - Trilliant Health, the leading analytics and market research firm in the healthcare industry, today released its newest report, Trends Shaping the Health Economy: Behavioral Health, uncovering massive shifts in the American behavioral health market. The report, which analyzes extensive data from a variety of third-party resources and Trilliant Health’s proprietary all-payer claims database, details behavioral health demand, supply and yield trends.

Overall, the report found that the demand for and prescription use for behavioral health care has dramatically increased in America since the onset of the COVID-19 pandemic. Though behavioral health visit volumes were relatively flat prior to 2020, by Q2 2022, they were 18% above pre-pandemic levels, and demand grew faster than the national average in nine of the 10 largest metropolitan core-based statistical areas (CBSAs).

Notably, Trilliant Health’s analysis suggested that unlike other aspects of healthcare, behavioral health trends are not a function of a small group of high utilizers driving higher volumes. Rather, in 2021, two-thirds (66%) of patients diagnosed with a mental health condition saw a provider five or fewer times that year.

Additionally, anxiety and depressive disorders catalyzed the significant increase in visit volumes. In the first half of 2021, these conditions represented 40% of all behavioral health visits. Yet, when analyzing volumes over time, neither condition group had the highest growth rate. Since 2019, visit volume for eating disorders grew the most (52.6%), followed by anxiety (47.9%), alcohol- and substance-use disorders (27.4%), depression (24.4%) and bipolar disorder (12.2%).

“While the magnitude of the national behavioral crisis is well documented, less is known about how the pandemic changed the behavioral health care journey for patients. Our longitudinal analysis of how Americans accessed care and were treated for behavioral health conditions reveals that, despite increased investments in technology-enabled behavioral health services and inpatient psychiatric capacity, demand continues to outpace available supply,” said Trilliant Health Chief Research Officer and SVP of Market Strategy Sanjula Jain, Ph.D. “This mismatch is already resulting in fewer patients receiving specialized behavioral health care, increased prescription use and comorbidity risk, while also growing the total cost of care. These distressing trends suggest that by the laws of economics, the post-pandemic behavioral health market will likely increase the economic burden facing the U.S. healthcare system, which is already fast approaching 20% of GDP.”

Below are some of the macro trends outlined in the report, which is publicly available to download, with an option to access additional findings at the market, condition and prescription brand level through Trilliant Health’s premium research subscription.

Americans under 18 more frequently diagnosed with behavioral health conditions

With numerous reports chronicling the growing behavioral health challenges facing America’s youth, including a recent report from the CDC, Trilliant Health’s Behavioral Health Trends report reveals increasing behavioral health diagnosis rates for select conditions to be even greater for patients under 18 years of age than all other age cohorts. Between Q1 2018 and Q2 2022, diagnoses for eating disorders grew by more than 107.4% in the under 18 cohort, followed by depressive disorders at 44% and self-harm growing slightly at 2.35%.

Consequently, prescribing for mental health treatment now represents a larger percentage of all prescriptions given to people under 18 years old. Between 2017 and 2021, prescriptions for treating mental health grew from approximately 16.2% to 21.8% of all prescriptions for this age group, representing a 35% increase.

Prescribing for mental health grows across the board, creating numerous implications

The share of prescriptions for treating all mental health conditions – including for anxiety, depression, ADHD and more serious mental health conditions – has grown annually as a percentage of all prescriptions since 2017, rising to 21.5% in 2021.

Notably, while prescriptions for Adderall and its generic to ADHD patients under 21 and over 45 remained relatively consistent with pre-pandemic levels, prescriptions skyrocketed by 58.2% in the 22-44 age cohort from Q1 2018 to Q2 2022, an area of potential concern given the known side effects of Adderall. In fact, Trilliant Health’s analysis found that patients with a history of stimulant use experience higher rates of medical conditions like hypertension, sleep disorders and other issues. Thus, it is important to consider whether rising rates of stimulant prescriptions will lead to increasing demand for treatments for comorbidities over time, creating a higher cost of care per patient.

Smaller share of patients are receiving behavioral health services in emergency departments (ED), yet those that do are falling through the cracks

While Trilliant Health’s analysis uncovered that the overall share of behavioral health visits to the ED has decreased relative to other care settings, approximately half (49.9%) of patients who visited the ED for depression or anxiety did not receive follow-up care from a behavioral health provider within 60 days.

Even more concerning, 84% of patients who went to the ED for alcohol or substance use disorder treatment did not receive follow-up inpatient or residential treatment center care within 60 days. Perhaps unsurprisingly, 9.5% of these patients who were treated in the ED recorded a return visit to the ED within 30 days.

Total cost of care for patients with physical and behavioral health comorbidities is higher

While it is well-known that patients with physical health comorbidities like diabetes and hypertension incur increased costs of care, Trilliant Health’s research reveals that a behavioral health morbidity like depression results in even higher total cost of care. After analyzing a cohort of patients being treated for diabetes, hypertension and depression, the total cost of care was 20% higher compared to patients with diabetes and hypertension alone.

As mental health screenings for certain patient populations become increasingly recommended as part of routine care – with some policy experts calling for them to be extended to all U.S. adults – the total costs of care for all patients will also likely rise, constraining the existing limited supply of clinician resources and potentially exacerbating access issues for underserved communities.

Additional key insights from the Trends Shaping the Health Economy: Behavioral Health report include:

• Behavioral health accounts for a greater share of telehealth visits, increasing from 34.4% in Q2 2019 to 63.8% in Q2 2022.
• However, utilization of telehealth for behavioral health services has increased 45X since the beginning of the pandemic. Less than 1% of all behavioral health visits were virtual in 2019, but that rose to 32.8% by Q2 2022.
• Behavioral health demand forecasts reveal that by 2026, 25.2% of Americans will require behavioral health services, which is 1.2 percentage points above observed 2021 levels. This proportion could be even greater when factoring in the effects of policies such as new screening recommendations from the U.S. Preventive Services Task Force.
• From 2018 to 2021, behavioral health visits increased the most for psychiatric nurse practitioners (+79.8%) and declined the most for psychiatrists (-1.3%).
  
  
  

About Trilliant Health

Trilliant Health combines healthcare industry expertise, market research and predictive analytics to develop Evidence-Based Strategy for Healthcare™. Trilliant Health's proprietary analytics platform produces a comprehensive understanding of local market dynamics, providing exponentially better data insights to maximize returns from growth strategies. For more information, please visit trillianthealth.com.