How behavioral healthcare can drive down the cost of chronic disease

Achieving the healthcare Triple Aim – improved health across patient populations, reduced per capita care costs and an enhanced patient experience – is a common goal among healthcare organizations. As a result, many ACOs, payers and providers are now evaluating ways to effectively address those chronic diseases that tend to consume the most resources and contribute the most to rising costs.

Yet even with a focus on comprehensive and accountable care, organizations too often overlook a key element in the successful treatment of chronic conditions: the integration of mental healthcare. The inclusion of behavioral health allows providers to tackle mental health issues that are proving to be key contributors to chronic disease occurrences and hospitalizations.

In fact, the need for more tightly integrated behavioral and clinical care is illustrated by a recent study that finds mental illness is widespread among the highest-cost, most frequently hospitalized Medicaid beneficiaries.[1] A similar report reveals roughly 49 percent of Medicaid beneficiaries with disabilities have a psychiatric illness.[2] Based on these findings, ACOs are realizing the importance of treating behavioral healthcare concerns in patients with chronic diseases.

An industry-wide issue

The impact of mental illness on chronic conditions isn’t limited to Medicaid patients. Across the board, roughly 70 percent of diabetic patients and an estimated 40 – 65 percent of patients who have experienced a heart attack have mental health issues and suffer from depression.[3]

While many links between mental and physical health likely exist, among them are challenges presented by behavioral health conditions that reduce a patient’s motivation to seek medical care and to adhere to treatment plans consistently.[4] Therefore, those patients who do pursue treatment must deal not only with their chronic conditions, but also with potential feelings of guilt or blame about behaviors that might have exacerbated those conditions.

For example, diabetic patients find it hard to conform their diet changes into their daily lifestyle, despite knowing that it’s critical for their health. Yet without appropriate and effective behavioral intervention, blood sugar spikes often continue which over time causes heart disease. Without professional mental healthcare involvement in discharge planning and follow-up, these patients often incur hospital readmissions.

However, treatment of mental illness for the nation’s chronically ill cannot come solely from in-person care. The problem is that the availability of mental health caregivers cannot scale to meet the increasing demand.

The U.S. Health Resources and Services Administration defines Health Practitioner Shortage Areas (HPSAs) as geographic areas, population groups or facilities that have a shortage of primary medical care, dental or mental health providers. The Administration has identified 3,291 mental health HPSAs with 80 million people living in them, and calculates that it would take 5,338 new mental health practitioners to meet the needs of these 80 million people.[5]

Simply put: There are not enough behavioral health specialists to meet the need to integrate behavioral health with primary care. It is simply not practical to add 5,338 mental health practitioners to the U.S. healthcare system anytime soon. Still, a major barrier to improving the health of the population at large will remain until mental healthcare is integrated into these patients’ primary care programs. Consequently, as with many new initiatives in healthcare, information technology is playing a central role.

Telehealth mental health closes the gap

Nearly 80 percent of people in the U.S. have high-speed Internet access, with intelligent mobile devices catching up. Thanks to a convergence of technologies, these connections and devices can be used to supply economical telehealth mental health services that provide high-quality and effective treatments  – as well as improve the overall patient experience  – while addressing underlying contributors to problematic chronic diseases. Unlike in-person care resources, these solutions can be scaled immediately.

It is important, though, that any telehealth mental health program enlisted to close the gap between behavioral health and primary care be evidence-based and outcomes-focused, supported by clinical research that validates efficacy. It should offer not just better access to care, but expanded choices and extended care paths that improve the patent experience while delivering outcomes equivalent to face-to-face treatment.

In many ways, telehealth mental health services should dovetail with the overarching goals of both accountable care and the Triple Aim. As noted in the recent Mental Illness Surveillance Among U.S. Adults, the CDC concludes that the treatment of mental illnesses associated with chronic diseases can reduce the effects of both and support better outcomes.[6]

Furthermore, as numerous health leaders have attested, mental healthcare is essential to improving population health and reducing costs related to chronic disease. That is why Medicaid directors now consider initiatives to integrate physical and behavioral health care to be one of their top priorities.[7]

The shortage of mental healthcare providers doesn’t have to perpetuate barriers to care. Telehealth mental health solutions and the near-ubiquity of digital communications enable the ready deployment of evidence-based and effective mental health resources that foster treatment of the whole patient, addressing both physical conditions and the underlying mental health issues that so often have a deleterious effect upon them.

[1] C. Boyd et al. “Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services,” Center for Health Care Strategies, Dec 2010. http://www.chcs.org/resource/faces-of-medicaid-clarifying-multimorbidity-patterns-to-improve-targeting-and-delivery-of-clinical-services-for-medicaid-populations/

[2] Kronick R et al., “Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions,” Center for Health Care Strategies, October 2009. www.chcs.org/media/Faces_of_Medicaid_III.pdf

[3] http://www.mentalhealthamerica.net/conditions/co-occurring-disorders-and-depression

[4] Centers for Disease Control and Prevention, “Mental Illness Survey Among U.S. Adults,” www.cdc.gov/mentalhealthsurveillance/documents/MentalIllnessSurveillance_FactSheet.pdf

[5] U.S. Health Resources and Services Administration. “Shortage Designations: HPSAs and MUA/Ps,” www.hrsa.gov/bhpr/shortagedesignation/

[6] Centers for Disease Control and Prevention, “Mental Illness Survey Among U.S. Adults,” www.cdc.gov/mentalhealthsurveillance/documents/MentalIllnessSurveillance_FactSheet.pdf

[7] Kaiser Family Foundation, “Integrating Physical and Behavioral Health Care: Promising Medicaid Models,” Feb 12, 2014, http://kff.org/report-section/integrating-physical-and-behavioral-health-care-promising-medicaid-models-issue-brief/