Background: There is an increasing appreciation of the interconnection between chronic illnesses such as type-2 diabetes and behavioral health conditions such as depression and anxiety, as well as more serious behavioral health conditions. The separation of practice and payment for medical and behavioral conditions is ripe for disruption. This is of particular importance for risk-bearing entities.

Methods: Level2 is a virtual accountable care organization taking total cost-of-care risk for a commercially insured population. Using a de-identified administrative claims research database, we estimated the behavioral health profile of our enrolled population by examining the prescribing of common behavioral health medications.

Results: In our enrolled population of 7,361 members, the average age was 54.4 years, and the M:F ratio was 53:47. Prescriptions for behavioral health medications were demonstrated in 26.2% of the population. Medications for depression and anxiety were most common (20.0% and 8.0% respectively) , while antipsychotics were prescribed in 0.1% of attributed members. Twenty-four months of enrollment (November 2019- November 2021) showed stable prescribing patterns.

Conclusion: The movement towards provider risk bearing, and a more sophisticated understanding of the relationship between physical and behavioral health, necessitate a more comprehensive and integrated approach to care for patients. While this intersection may be evident to providers in their daily activities, the analysis of a population of nearly 7,400 members gives a broader insight into this challenge and calls for clinical service redesign, the application of new methodologies and measurements, and over time, new payment models. Of note, the prescribing data spans the COVID and pre-COVID periods and was stable over time, so the high use of behavioral health medications is not COVID-attributable.


D.J.Cook: None. A.Defail: Employee; Level2. C.Livesey: Advisory Panel; Compass Pathways, Employee; UnitedHealth Group. D.Pederson: Employee; Level2.

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