Switching from Medicare Advantage to traditional Medicare was associated with increased mental health visits, along with a shift toward nurse practitioners and away from emergency and internal medicine specialists, according to a December study published in the American Journal of Managed Care.
Researchers from Johns Hopkins Bloomberg School of Public Health examined mental health utilization patterns 12 months before and 12 months after beneficiaries switched from MA to traditional Medicare in 2018. The analysis used MA encounter data, traditional Medicare claims, and OneKey provider directory data to track visit frequency and provider specialty. Of the 32,710 beneficiaries who switched coverage that year, 1,184 (representing 11,015 claims) met the study’s criteria of having at least one mental health visit in both periods.
Five notes:
- Mental health visits increased after switching, from a median of 8 visits under MA to 9 visits under traditional Medicare. Most visits in both settings were for mood disorders, including major depressive disorder and bipolar disorder.
- Nurse practitioner visits for mental health care increased 87% after switching, from a mean of 0.54 visits to 1.01 visits per beneficiary. The share of mental health services delivered by nurse practitioners rose from 12.3% to 20.5%.
- There was no significant change in visits with psychiatrists or family medicine specialists after switching. However, among the 821 beneficiaries who did not see a psychiatrist while enrolled in MA, 10% saw one after switching to traditional Medicare, compared with 2.1% of MA members who saw a psychiatrist the following year.
- Visits with internal medicine and emergency medicine specialists for mental healthcare declined 24.2% and 26.1%, respectively, after beneficiaries switched to traditional Medicare.
- The authors noted that prior research has found that more than two-thirds of MA plans included less than 25% of local Medicare-accepting psychiatrists in their networks. The study findings suggest MA network restrictions may create barriers to mental healthcare access that prompt some beneficiaries to switch back to traditional Medicare.
