Can health insurance data help America’s behavioral health and substance use crisis?
By harnessing the insights derived from health data, providers, benefits advisors, insurers, policymakers, and researchers can work together to develop targeted interventions, improve treatment effectiveness, and create a more comprehensive and effective approach to behavioral health and SUD care.
The CDC reported approximately 100,000 drug overdose deaths in the U.S. in 2021, the highest number ever recorded and a staggering 28.5% increase from the previous year.
Compounding the problem? Almost a fifth of the country has a diagnosed anxiety disorder, impacting the nation’s already strained health care system, and these disorders can start as early as puberty. They can also lead to worsened mental and physical conditions such as depression, substance abuse, chronic pain, poor quality of life, and suicide.
Let’s not sugarcoat it: We are in crisis. And current treatment models for substance use disorders (SUD) and behavioral health aren’t working.
Unlocking the right health insurance data — at both the individual patient and population levels — is critical to reversing America’s behavioral health and SUD epidemic.
How can data help?
Health care data is complex, fragmented, and often incomplete. In behavioral health, the data reality is especially dire.
Patient data on behavioral health and substance abuse is often kept separate from other medical records due to a lack of interoperability, regulatory constraints, and underinvestment in health IT. But, if insurance carriers could quickly and securely disseminate reliable behavioral health data, providers could develop more effective treatment plans based on a patient’s complete history.
Simply put, SUD and behavioral health facilities, often at much earlier stages of data maturity than their traditional health care counterparts, stand to benefit the most from a healthy
injection of actionable and rich data from health insurance providers to improve the current care equation.
Empowering better patient care through data
Health insurance providers can use several processes and data best practices to build a robust data foundation and better collect, share, and analyze data for behavioral health and SUD treatment providers.
- Determining patterns and risk factors
Insurance providers have access to a wealth of data on health care utilization, claims, and patient demographics. By analyzing this data, insurers can identify patterns and risk factors associated with mental health and substance abuse. They can identify higher-risk populations, geographic hotspots, and social determinants of health (SDoH), which affect as much as 50% of county-level variation in health outcomes. This information can help target interventions and preventive measures.
- Enhancing care coordination
Health insurance data can improve care coordination for individuals with behavioral health issues and SUD. By analyzing claims data and treatment history, insurers can identify care gaps, ensure appropriate referrals to specialists, and coordinate services across different providers. This analysis can help improve continuity of care and prevent individuals from falling through the cracks of the health care system.
- Identifying effective treatment approaches
Insurance providers’ data can be leveraged to identify effective treatment. By analyzing outcomes data, providers can identify which interventions yield positive results and have better long-term outcomes. This information can guide insurance coverage decisions and encourage the adoption of evidence-based practices.
- Predictive analytics, early intervention, and data depth and accuracy
Advanced data science algorithms and predictive analytics can identify individuals at risk of developing mental health or substance abuse issues. Moreover, data sets like the social vulnerability index can further enrich patient-level information. Providers can identify those who might be at higher risk by analyzing various data points such as medical history, prescription drug data, and utilization patterns. This data synthesis allows for early intervention and proactive support, potentially preventing the escalation of these issues.
- Improving access to care
Insurance carriers can track and analyze treatment outcomes and quality of care data. By analyzing provider networks and geographic coverage data, insurers can identify areas with limited access to care. This information can help drive efforts to expand provider networks, improve reimbursement rates, and increase access to appropriate services for individuals in need.
- Monitoring treatment outcomes and quality of care
Data on treatment outcomes and the quality of care can be tracked and analyzed by insurance carriers. By measuring and comparing performance across providers, insurers can identify variations in quality, identify best practices, and incentivize the delivery of high-quality care. This data-informed approach can help improve the overall quality and effectiveness of behavioral health and SUD treatment services.
Optimizing benefits offerings through data
Further, for benefits brokers and advisors, leveraging health insurance data can provide numerous advantages in assisting clients with their insurance needs and optimizing their benefits offerings. Some crucial ways health insurance data can benefit brokers and advisors include:
- Informed plan selection
Thoroughly examining health insurance data enables brokers and advisors to analyze historical claims and utilization patterns, guiding clients in selecting the most suitable and cost-effective plans tailored to their health care needs.
- Cost containment and plan optimization
By analyzing health insurance data, brokers and advisors are empowered to identify cost drivers, optimize plan designs, negotiate competitive rates, and implement cost-saving measures, ensuring clients receive maximum value from their insurance plans while effectively managing costs.
- Employee engagement and communication
By leveraging health insurance data on employee health care utilization and preferences, brokers and advisors can tailor targeted engagement strategies and communication campaigns to educate employees about their benefits, encourage proactive health care choices, and enhance overall employee satisfaction with their insurance coverage.
- Compliance and regulatory support
Comprehensive health insurance data enables brokers and advisors to stay informed about evolving health care regulations, ensuring clients’ benefit plans comply with regulatory standards and guiding clients through complex compliance issues such as reporting, privacy regulations, and plan design requirements.
By utilizing the power of health insurance data, brokers and advisors can enhance their expertise, deliver more value to clients, and navigate the complex landscape of health care insurance more effectively.
Data considerations and the future
It is important to note that while health care insurance data holds great potential, challenges and ethical considerations are also associated with its use. Safeguarding patient privacy, ensuring data security, and maintaining compliance with regulations and standards are crucial aspects that must be carefully addressed when leveraging health care insurance data for improving behavioral health and substance use outcomes.
Health care insurance data can be a powerful tool to address America’s behavioral health and substance use crisis. By harnessing the insights derived from this data, health care providers, benefits advisors, insurers, policymakers, and researchers can work together to develop targeted interventions, improve treatment effectiveness, and ultimately create a more comprehensive and effective approach to behavioral health and SUD care.
Ty Wang is the co-founder and CEO of Angle Health.