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Stakeholder Benefit from Depression Disease Management: Differences by Rurality?

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Abstract

Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization and work costs, respectively) in two delivery systems (rural and urban). This study examined the main and differential effects of depression care management on outpatient utilization and work costs over 24 months in a preplanned secondary analysis of 479 depressed patients from rural and urban primary care practices in a randomized controlled trial. Over 24 months, the intervention did not significantly reduce outpatient utilization costs in the entire cohort (−$191, 95% confidence interval (CI) = −$2,083 to $1,647), but it did decrease work costs (−$1,970, 95% CI = −$3,934 to −$92). While not statistically significant, rural–urban differences in work costs were in the same direction, while rural–urban differences in utilization costs differed in direction. These findings provide preliminary evidence that employers who elect to cover depression care management costs should receive comparable economic benefits in the rural and urban employees they insure. Given the limited sample size, further research may be needed to determine whether health plans who elect to cover depression care management costs will receive comparable economic benefits in the rural and urban enrollees they insure.

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Acknowledgements

This research was supported by the Health Resources and Services Administration (HRSA ORHP U1CRH03713-01-00) and the Quality Improvement for Depression Cooperative Study (MH54444).

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Authors and Affiliations

  1. Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA

    Stanley Xu PhD

  2. Department of Biometrics, School of Public Health, University of Colorado Health Sciences Center, Denver, CO, USA

    Stanley Xu PhD

  3. Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA

    Kathryn Rost PhD

  4. WICHE Mental Health Program, Boulder, CO, USA

    Fran Dong MS

  5. Department of Family Medicine, University of Colorado Health Sciences Center, Boulder, CO, USA

    L. Miriam Dickinson PhD

Authors
  1. Stanley Xu PhD
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  2. Kathryn Rost PhD
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  3. Fran Dong MS
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  4. L. Miriam Dickinson PhD
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Corresponding author

Correspondence to Stanley Xu PhD.

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Xu, S., Rost, K., Dong, F. et al. Stakeholder Benefit from Depression Disease Management: Differences by Rurality?. J Behav Health Serv Res 38, 114–121 (2011). https://doi.org/10.1007/s11414-009-9204-0

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  • DOI: https://doi.org/10.1007/s11414-009-9204-0

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