Does Insurance Type Matter on the Computer Too? Comparing Outcomes for Youth with Public v Private Health Insurance Attending a Telehealth Intensive Outpatient Program: A Quality Improvement Analysis (Preprint)
Authors: Gliske Kate , Berry Katherine A. , Ballard Jaime , Evans-Chase Michelle , Solomon Phyllis L. , Fenkel Caroline 
Published: August 2022

BACKGROUND

COVID-19 exacerbated a growing mental health crisis among youth and young adults, made worse by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOP) is one solution to overcoming geographic limitations to care. However, it is still unclear whether remote IOP engenders equivalent clinical outcomes among youth with public insurance (e.g., Medicaid) versus private insurance (e.g., commercial), given the disparities found in previous research of place-based treatment in both clinical and engagement outcomes.

OBJECTIVE

The analysis upon which the following report is based sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between those with public versus private insurance. Identification of disparities by payor type were used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted.

METHODS

Pearson’s chi-square analyses and independent t-tests were used to establish that the two groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, non-suicidal self-injury) at intake and to compare change in clinical outcomes. McNemar’s chi-square analysis and repeated-measures t-tests were used to assess changes in clinical outcomes between intake and discharge in the sample as a whole. A total of N=495 clients who attended the remote IOP for youth and young adults in 14 states, who participated in seven or more treatment sessions and who completed both intake and discharge surveys between July 2021 and April 2022 were included in analysis.

RESULTS

Overall, the youth and young adults in the remote IOP attended 90% of their scheduled group sessions (SD=16.48%) and reported significantly fewer depression symptoms at discharge (t447=12.51, P<.001). McNemar’s chi square tests of change indicated significant reductions from intake to discharge in suicidal ideation (X21, 470=19.2, P<.001), with nearly three quarters of youth who reported suicidal ideation at intake (n=201) no longer reporting it at discharge (n=143), and in NSSI (X21, 430=40.65, P<.001), with more than half of youth reporting NSSI at intake (n=206) reporting lower self−harm at discharge (n=120). No significant differences emerged by insurance type in attendance (Public Mdn=89%, Private Mdn=92%; P=.099), length of stay (t416= −.35, P=.73), or reductions in clinical outcomes [depressive symptom severity (t444= −.87, P=.38), active suicidal ideation (X21, 233=.03, P=.88), NSSI frequency (t426= −.98, p=.33)].

CONCLUSIONS

Findings suggest that remote IOP is a feasible and effective treatment solution for youth and young adults who are struggling with depression, suicidal ideation, and NSSI. Furthermore, when given access to the same accessible, high−acuity care, youth and young adults on both public and private insurance can be engaged in programming at comparable rates and achieve similar improvements in clinical outcomes.

CLINICALTRIAL

N/A