Real World Analysis of Insurance Churn among Young Adult Patients with Schizophrenia Using the Colorado All Payer Claims Database (CO-APCD)

Background
Schizophrenia (SCZ) likely leads to changes in and/or loss of employment, which can result in changes to insurance coverage or “churn”. Since patients with schizophrenia are typically diagnosed in their 20s, there is a need to understand the extent of insurance churn.

Methods
The Colorado-APCD is a comprehensive insurance claims database capturing 4 million commercial and public health plan enrollees. We identified young adults (18-34 years) with diagnosed SCZ (ICD-9: 295.xx; ICD-10: F20.xx, F25.xx) and a 25% random sample without SCZ (non-SCZ) for propensity score matching. Churn was defined as switch in insurance type. Time to churn and the percent of cumulative churns were calculated.

Results
SCZ and non-SCZ cohorts had 3,678 and 18,398 patients, respectively. At initial SCZ diagnosis, 71% of SCZ patients were on Medicaid vs 46% of non-SCZ; 13.9% and 51.3% of SCZ/non-SCZ patients were on commercial. Within those commercially enrolled, the median time to first churn was 12 (SCZ) vs 27 months (non-SCZ) (p < 0.001). Over the 12 months post-diagnosis, 38% of SCZ patients churned once (vs 20% non-SCZ), 12% churned twice (vs 11% non-SCZ), and 4% churned 3+ times (vs 3% non-SCZ). For those starting on Medicaid, 18% (SCZ) and 22% (non-SCZ) churned at least once in the first year.

 
Conclusions
While most young adults in CO with SCZ have Medicaid coverage at diagnosis and experience minimal insurance churn, those with commercial insurance experience more churn as do those with SCZ vs non-SCZ.  Insurance churn may lead to poor outcomes in this vulnerable population.