 Our Aim 1 measures of the quality of bipolar treatment will include indicators of patients access to appropriate care: prevalence and intensity of use of effective medications antipsychotics, anticonvulsants; medication adherence; and, guideline-recommended clinical monitoring regular outpatient mental health visits. Adverse events in Aim 2 will include psychiatric hospitalizations, which are potentially avoidable and often viewed as an indicator of suboptimal outpatient care. In Aim 3, we will assess changes under HDHPs in the co-payment amounts faced by patients for specific medical services, such as prescription fills and clinician visits, and the total burden of patient out-of-pocket costs. 