Mental Health, Obesity, Orphan Drugs Linked To High Cost Adolescent Care

Susan Gray MD Division of Adolescent Medicine Boston Children's Hospital Boston, Interview with:
Susan Gray MD
Division of Adolescent Medicine
Boston Children’s Hospital
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Gray: This is a study of the health care costs of 13,000 privately insured adolescents (13 to 21 years old) cared for in an association of pediatric primary care practices. We found that a tiny fraction (1%) of adolescents accounted almost a quarter of the expenses of the whole cohort. Mental health disorders were the most common diagnosis among these high cost adolescents. The characteristics most strongly associated with high cost were complex chronic medical conditions, behavioral health disorders, and obesity, but many high cost adolescents had no chronic conditions. Pharmacy costs, especially orphan drug costs, were a surprisingly large contributor to high costs for these privately insured adolescents. Primary care costs were very small in high cost patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gray: When designing interventions to improve care quality and reduce cost, pediatric health care providers and policy makers need to keep in mind that different strategies are needed for different populations. For adolescents with mental health disorders, integration of mental health care services into care management will be critical. For adolescents with complex chronic medical conditions, care management strategies to reduce hospitalization costs are needed. For adolescents who take orphan drugs, care management may not reduce cost at all. As pediatricians caring for adolescents enter into shared-risk, accountable care contracts, they need to be mindful of these differences.

It’s also important to note that health care costs for adolescents are very small in comparison to costs for neonates and the elderly.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gray: More research is needed about persistence of high costs over time for adolescents. More research is needed about medically complex children who do not have high costs. More research is neededĀ about the costs of privately insured children in different geographic areas of the United States, with comparison to costs of publicly insured children.



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Susan Gray MD (2015). Mental Health, Obesity, Orphan Drugs Linked To High Cost Adolescent CareĀ 

Last Updated on October 6, 2015 by Marie Benz MD FAAD