DNP Scholarly Projects

The Impact of High Deductible Health Plans on Mental Health Treatment

Abstract

Background and Rationale: High Deductible Health Plans (HDHPs) are designed to reduce overall healthcare spending by shifting more upfront costs to patients to discourage overutilization of care, yet HDHPs often increase financial burden, particularly in outpatient mental health care. Patients covered by HDHPs often face substantial out-of-pocket costs before reaching their deductible. This can lead to potential delays or discontinuation of psychiatric treatment. Financial transparency interventions by the mental health provider may mitigate these barriers through more-informed patient decision-making regarding payment options. This project evaluates the impact of a financial transparency intervention on reducing payment responsibility for HDHP patients in an outpatient psychiatric practice in Nashville, Tennessee.

SMART Aim: By December 31, 2024, 95% of patients aged 12 to 80 with HDHPs at A nurse practitioner owned private practice in Tennessee will experience a reduction in out-of-pocket costs through financial transparency interventions.

Methods: This quality improvement project followed the Iowa Model for evidence-based practice change and included a retrospective review of charts between August and December 2024. Data were collected from 145 patients who established care at A nurse practitioner owned private practice in Tennessee between January 1 and June 30, 2024, with a subset of 21 patients (14.5%) identified as having HDHPs. Financial transparency interventions included structured discussions led by a psychiatric nurse practitioner on insurance utilization, cash-pay options, and deductible impacts. Key outcome measures included the percentage of HDHP patients who experienced a reduced out-of-pocket (OOP) financial burden, provider time spent on financial transparency, and patient retention for the HDHP cohort.

Outcomes: Among HDHP patients, 81% (17 of 21) successfully reduced their payment responsibility, while 19% (4 of 21) did not meet the aim. Of those who did not meet the aim, three patients chose to continue using insurance despite higher OOP costs, and one discontinued care due to financial constraints. Financial transparency discussions accounted for 20.6% of provider working hours (95 out of 462 total hours). In 81% of cases, patients who opted for cash-pay over insurance achieved comparable or lower costs. One HDHP patient did not receive a financial transparency consultation and was therefore not included in the final data analysis.

Conclusion: While the project AIM was not met, the majority of HDHP patients at A nurse practitioner owned private practice in Tennessee experienced a reduced OOP payment responsibility following the financial transparency intervention. Barriers could remain for some HDHP patients who default to insurance-based payment or discontinue care due to cost concerns, while other HDHP patients could pay less over the course of the year due to meeting the deductible. These findings underscore the importance of financial literacy in mental health treatment. Mental health providers can play a key role in supporting patient decision-making and insurance utilization through financial transparency.

Streaming Media

Date

Spring 4-27-2025

First Advisor

Laura Gray, PhD, MSN, RN

Second Advisor

R. David Phillippi, PhD

Scholarly Project Team Member

Tesha Simpson, DNP

Department

Nursing, School of

College

Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project

Degree

Doctorate of Nursing Practice (DNP)

Degree Level

Doctoral

Degree Grantor

Belmont University

Keywords

High Deductible Health Plans; Mental health treatment; Financial transparency; Psychiatric care; Patient retention; Insurance utilization; Quality improvement; Cost reduction; Financial burden; Decision-making

Additional Files
DNP Project Poster DAMBRINO 2025_FINAL.pdf (511 kB)

This document is currently not available here.

Share

COinS