Better behavioral health ecosystem can improve outcomes

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While 50% of adults with a behavioral condition do not receive treatment, a robust ecosystem inclusive of early identification, along with personalized care pathways with patient to provider matching, can result in improved outcomes, according to new research published by Evernorth.

The demand for behavioral health providers continues to grow. Evernorth's analysis finds the prevalence of behavioral health conditions grew by 4% from 2021 to 2022. The analysis, which looks at anonymized and aggregated claims data of six million people from 2021 to 2022, finds that increases in prevalence vary by condition, with the largest occurring within attention-deficit hyperactive disorder (ADHD), personality disorder and autism spectrum disorder.

The data also shows that the 22% of patients with a diagnosed behavioral condition drive 41% of total healthcare spend for the entire population.

WHAT'S THE IMPACT?

Costs for patients with a medical condition and behavioral condition are two to three times higher than for patients without a behavioral condition.

In an effort to better understand behavioral health patients, the research uncovered four "patient journeys" based on their healthcare utilization:

• Willing engagers, who receive treatment from a behavioral health provider.
• Self-directed seekers, who are currently seeking treatment from a medical provider.
• Complex copers, who receive services for a chronic physical health condition and have one or more co-occurring behavioral health conditions.
• Silent sufferers, who may not yet have been diagnosed as having a behavioral health need.

Among patients with a behavioral condition, the research finds that 87% also have one or more medical conditions, such as a circulatory, endocrine, or musculoskeletal disorder or disease. When behavioral conditions go untreated, the co-occurring medical conditions can actually worsen. This can impact healthcare costs. 

On the bright side, the data shows that effective behavioral health treatment – adherence to antidepressant medication, or three-plus behavioral outpatient visits – can reduce this spend. For example, patients with Type 2 diabetes and major depressive disorder who receive behavioral treatment show a medical savings of $1,649 per member per year, compared to patients who receive insufficient behavioral care.

THE LARGER TREND

A KFF analysis from January showed the mental health crisis is disproportionately straining Medicaid, in part because behavioral health services cost the federal program more than for other payers.

In addition, workforce challenges contribute to barriers in access to care and nearly half the U.S. population – 47%, or 158 million people – live in a mental health workforce shortage area. Workforce challenges are widespread and go beyond Medicaid, but shortages may be exacerbated in Medicaid, according to the analysis.

ON THE RECORD

"Improving care begins with recognizing the long and chaotic road to finding effective treatment," said Dr. Doug Nemecek, chief medical officer for behavioral health quality, integration and clinical operations at Evernorth. "Finding a therapist who has demonstrated effective treatment for someone's specific behavioral health condition is not easy. For one, the demand for care is much higher than the supply of providers, which often leads to delays in care, poor patient outcomes and higher healthcare costs."

"PCPs are serving on the frontline of our growing mental health crisis in the U.S and these personas further demonstrate the important role PCPs play in screening and navigation to behavioral care," said Eva Borden, president of Behavioral Health at Evernorth. "We must arm PCPs with the training, resources and tools to support people who need behavioral healthcare."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com