Quantifying the economic impact of a digital self-care behavioral health platform on Missouri Medicaid expenditures

J Med Econ. 2018 Nov;21(11):1084-1090. doi: 10.1080/13696998.2018.1510834. Epub 2018 Aug 31.


Aim: The primary objective of this study is to estimate the economic benefits relative to return on investment (ROI) of a state-wide initiative to integrate digital behavioral health (BH) self-care into the community BH system.

Methods: The observational study reviewed claims data of 799 people who registered with the digital tool (myStrength) and 715 matched control study participants. The control group was formed via coarsened exact match with blocking variables, including presence on the claims file, volume of health care utilization, participation in a medical health home, BH diagnosis and volume of psychotherapy claims. The primary study analysis of cost differences for the BH self-care tool group versus the control group were calculated by cost setting and the ROI of the BH self-care tool was estimated. Cost settings assessed include inpatient, emergency services, general and psychiatric outpatient, and outpatient psychotherapy.

Results: An incremental annual difference in difference reduction of $382 per user was observed over the 11 month study period in the self-care tool group. Sensitivity analysis indicated an ROI of between 142% and 695%.

Conclusions: Augmenting BH offerings to include digital BH self-care tools appears to generate positive ROI via reduced total cost of care.

Keywords: Depression; I10; I19; claims; digital behavioral health; health care cost; population health; return on investment.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Community Mental Health Services / economics
  • Community Mental Health Services / organization & administration*
  • Female
  • Humans
  • Male
  • Medicaid / economics*
  • Mental Disorders / economics
  • Mental Disorders / therapy*
  • Missouri
  • Mobile Applications / economics*
  • Models, Econometric
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient-Centered Care / economics
  • Self Care / economics
  • Self Care / methods*
  • United States