Provider Type Market Share for Treatment of Depression in a Large Commercially Insured Population

OBJECTIVE: This study aimed to examine the distribution of differing types of professionals providing depression care for a large sample of commercially insured patients. METHODS: The Blue Cross Blue Shield Axis database, which includes >60 million commercially insured individuals, was used to conduct a cross-sectional observational study of 133,886 members with claims for major depressive disorder in January 2019. RESULTS: Of the sample, 9.7% (N=13,053) received depression-related care from both a mental health professional and a primary care physician (PCP) in the year following diagnosis, 38.8% (N=52,013) were treated exclusively by a mental health professional, and 33.6% (45,007) were treated exclusively by a PCP. For the remaining 17.8% (N=23,813) of members, provider types in claims were listed as "other" or unspecified. Annual health care expenditures and number of visits were lowest for patients receiving depression-related care from PCPs only and highest for those being treated by both mental health professionals and PCPs. A greater percentage of patients with higher diagnostic severity visited both mental health and primary care providers compared with patients with lower severity. CONCLUSIONS: Patients experiencing depression visit a wide variety of providers. PCPs infrequently treated patients for depression more than once annually and were associated with patients with lower annual health care expenditures and lower diagnostic severity. However, outcomes associated with different approaches to depression management are not clearly understood. Randomized trials or trials simulating randomization that compare outcomes for patients managed by different types of health care professionals, with different treatment modalities and frequencies, are needed.