Real-world analysis of insurance churn among young adults with schizophrenia using the Colorado All-Payer Claims Database

Abstract

METHODS: The Colorado All-Payer Claims different insurance types were calculated Database, containing insurance claims data monthly to assess churn events. Cohorts were BACKGROUND: Most patients with schizo-from commercial and public insurers for compared using descriptive statistics, Cox phrenia are diagnosed in their early twenties Colorado residents, was used for the study. proportional hazards, and generalized esti- and often have commercial insurance at Eligible patients were required to have at mating equation models. diagnosis. These young adults can experi-least 1 inpatient or 2 outpatient claims for RESULTS: The matched schizophrenia and ence changes in insurance coverage, that is, schizophrenia or schizoaffective disorder, nonschizophrenia cohorts comprised 501 “churn,” which can lead to disruptions in care. be of age 18-34 years at index, have previ- and 2,510 members, respectively. Before ous insurance coverage for 12 consecutive OBJECTIVE: To examine the frequency, PSM, cohorts were imbalanced (schizophre-months, and have commercial insurance at speed, and type of insurance churn events in nia cohort had a younger median age and diagnosis. These patients were 1:5 propensity a young adult schizophrenia population with higher proportion of males). After match-score matched (PSM) with nonschizophrenia ing, the cohorts were similar in terms of the commercial insurance coverage at diagnosis. members. Percentages of members on 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.