Real-world analysis of insurance churn among young adults with schizophrenia using the Colorado All-Payer Claims Database
Real-world analysis of insurance churn among young adults with schizophrenia using the Colorado All-Payer Claims Database
复制标题
使用科罗拉多州全付款人索赔数据库对患有精神分裂症的年轻人的保险流失进行真实世界分析
DOI：
10.18553/jmcp.2022.28.1.26
复制
发表时间：
2022
影响因子：
2.1
通讯作者：
C. Benson
中科院分区：
文献类型：
--
作者：
J. Pesa;D. Rotter;E. Papademetriou;R. Potluri;Charmi A. Patel;C. Benson
背景：大多数精神分裂症患者在20岁出头时被诊断出来，并且在诊断时通常有商业保险。这些年轻人可能会经历保险范围的变化，即"流失"，这可能导致护理中断。目的：研究在诊断时有商业保险的年轻成年精神分裂症人群中保险流失事件的频率、速度和类型。方法：该研究使用了科罗拉多所有付款人索赔数据库，其中包含来自科罗拉多居民的商业和公共保险公司的保险索赔数据。符合条件的患者需要至少有1次住院或2次门诊精神分裂症或情感性精神障碍索赔，指数时年龄为18 - 34岁，连续12个月有既往保险，诊断时有商业保险。这些患者与非精神分裂症成员1：5倾向评分匹配（PSM）。每月计算不同保险类型的会员人数，以评估流失事件。使用描述性统计量、考克斯比例风险和广义估计方程模型对队列进行比较。结果：匹配的精神分裂症和非精神分裂症队列分别包括501和2,510名成员。在PSM之前，队列不平衡（精神分裂症队列的中位年龄较低，男性比例较高）。匹配后，队列在匹配的基线特征方面相似。精神分裂症队列（75%）比非精神分裂症队列（26%）更常见既往精神健康障碍。在12个月后，精神分裂症和非精神分裂症队列中至少发生1次流失事件的成员比例分别为53.8%和36.5%，48个月后分别为84.6%和69.2%。精神分裂症组的首次流失时间（16个月）显著短于非精神分裂症组（23个月; P <0.001）。在第一个和第二个6个月期间，精神分裂症队列成员每月每1,000名成员中有64.1和56.8起流失事件，而非精神分裂症队列成员每月每1,000名成员中有43.0（P ≤ 0.001）和42.8（P = 0.011）起流失事件。参加公共保险的精神分裂症和非精神分裂症群体的成员比例在12个月后分别为22.9%和6.9%，48个月后分别为52.4%和10.7%。在精神分裂症队列中，最常见的流失事件类型是从商业保险到公共保险，而不是不同的商业保险;值得注意的是，41%的成员在诊断后4年仍在使用商业计划。结论：在索引日期后的前4年研究中，患有精神分裂症的年轻人比没有精神分裂症的人更快更频繁地经历了流失事件。这些中断可能与这一弱势患者群体获得护理和治疗的机会减少有关。
BACKGROUND: Most patients with schizophrenia are diagnosed in their early twenties and often have commercial insurance at diagnosis. These young adults can experience changes in insurance coverage, that is, “churn,” which can lead to disruptions in care. OBJECTIVE: To examine the frequency, speed, and type of insurance churn events in a young adult schizophrenia population with commercial insurance coverage at diagnosis. METHODS: The Colorado All-Payer Claims Database, containing insurance claims data from commercial and public insurers for Colorado residents, was used for the study. Eligible patients were required to have at least 1 inpatient or 2 outpatient claims for schizophrenia or schizoaffective disorder, be of age 18-34 years at index, have previous insurance coverage for 12 consecutive months, and have commercial insurance at diagnosis. These patients were 1:5 propensity score matched (PSM) with nonschizophrenia members. Percentages of members on different insurance types were calculated monthly to assess churn events. Cohorts were compared using descriptive statistics, Cox proportional hazards, and generalized estimating equation models. RESULTS: The matched schizophrenia and nonschizophrenia cohorts comprised 501 and 2,510 members, respectively. Before PSM, cohorts were imbalanced (schizophrenia cohort had a younger median age and higher proportion of males). After matching, the cohorts were similar in terms of the matched baseline characteristics. Previous mental health disorders were more common in the schizophrenia cohort (75%) than in the nonschizophrenia cohort (26%). The proportion of members with at least 1 churn event for the schizophrenia and nonschizophrenia cohorts, respectively, were 53.8% vs 36.5% after 12 months and 84.6% vs 69.2% after 48 months. Time to first churn event was significantly shorter in the schizophrenia cohort (16 months) than the nonschizophrenia cohort (23 months; P < 0.001). Schizophrenia cohort members had 64.1 and 56.8 churn events per 1,000 members per month vs 43.0 (P ≤ 0.001) and 42.8 (P = 0.011) churn events for nonschizophrenia cohort members in the first and second 6-month periods, respectively. Proportions of members in the schizophrenia and nonschizophrenia cohorts on public insurance, respectively, were 22.9% vs 6.9% after 12 months and 52.4% and 10.7% after 48 months. In the schizophrenia cohort, the most common churn event type was from commercial to public insurance rather than to a different commercial insurance; notably, 41% of members were still on a commercial plan 4 years after diagnosis. CONCLUSIONS: Young adults with schizophrenia experienced churn events more rapidly and more frequently than those without schizophrenia for the first 4 years studied after the index date. These disruptions may be associated with reduced access to care and treatment gaps in this vulnerable patient population.