Author: Angela Smith-Hietikko, Vice President, Clinical Management & Behavioral Health
The United States spends extravagantly on healthcare, representing approximately 18 percent of the nation’s economy—nearly double what other developed countries spend—but despite what the United States spends on healthcare, we have worse health outcomes compared to other industrialized nations.1 Health plans, employers, and consumers bear the burden of this cost.2 Health plans routinely examine ways to reduce costs in the face of such spending with behavioral health conditions, like mental health and substance use problems, becoming more widely recognized and acknowledged as accounting for a large portion of those expenditures, particularly when these conditions are linked closely to patients’ physical health.3
Many health plans are aware of the need for additional mental health investment and support, and some are in the early stages of responding to the issue by shifting to an integrated behavioral health care model.
Allocating more spending toward mental health issues can help, too. In 2020, the White House reported that around $280 billion was spent on mental health services, about a quarter of which was from Medicaid.3 The healthcare industry is still learning how to improve access to mental health treatment and support. And health plans are still discovering what changes they can make to not only improve outcomes but rein in the significant spending that is currently unable to address members’ actual health needs.
In light of the current complexities, how can health plans move forward with making mental and substance use healthcare accessible? Health plans are adopting new models to care for complex patients, identifying impactable high-cost members to engage them on their healthcare journey. We know health plans that can adequately address the complexities of behavioral health access and treatment will be positioned well for success in improving members’ quality of care while reducing overall healthcare spend. Ensuring mental healthcare access and integration of services are essential to that achievement.4
Discover the major factors that complicate behavioral healthcare access and exacerbate mental health disparities and how health plans can better support their members.
Effects of COVID-19 on Mental Health
A challenge in treating behavioral health is that mental health and substance use conditions have been exacerbated since the COVID-19 global pandemic. Research from the Centers for Disease Control and Prevention (CDC) shows that before the pandemic, about 20 percent of adults in the United States had a mental health condition. Since the pandemic began, rates of anxiety and depression—two of the most common mental health disorders—have increased over 300 percent since March 2020, while suicidal thoughts have more than doubled.5
As of October 2020, a study found that only 4.4 percent of healthcare costs for all participants were for behavioral health treatment.6 The reasons for this are as varied and unique as the patients themselves, but ultimately it comes down to the fact that many Americans do not participate in the health system or use all the healthcare services they require. Some may have had difficulties seeking treatment during the pandemic (access to care), or their providers lacked the availability to see them as needed. Partially to blame for this lack of access is the current shortage of behavioral health professionals; workforce shortages, especially within Medicaid services, have caused recent action at both federal and state levels to address the lack of available providers, but the problem lingers.7
The result? Members are either not receiving the intensity of care needed to see meaningful improvements or they are going without treatment entirely. These issues are cause for significant concern, not only for members going without care but also for health plans burdened by the additional health problems members have when behavioral health conditions are left untreated.
Causes of Ballooning Healthcare Costs
When behavioral health conditions are left untreated, we often see poorer physical health outcomes that drive increased healthcare costs, exacerbating problems for patients, payers, providers, and society.
Identified below are behavioral health conditions across all age demographics that account for the majority of cost expenditures to health plans in the United States:
- Anxiety & Depression
Mood disorders, like anxiety and depression, are relatively inexpensive to treat per patient—the issue lies in the number of people who need treatment for these conditions.2 When health plans effectively manage the treatment of members for anxiety or depression, individual spending is cost-effective, and behavioral health outcomes are improved. An important consideration is that anxiety and depression are highly correlated with chronic disease, thus effectively addressing underlying behavioral health conditions should result in improved management of chronic disease and lower overall cost of care.
- Substance Use & Addiction
Many patients who suffer from substance abuse and dependence have other mental and physical health morbidities making it difficult to calculate the exact costs associated with these conditions.2 Underreporting and the opioid epidemic have only compounded the problem. While evidence-based treatment options for addiction have expanded over the last decade, identifying and treating patients with substance use disorders is a significant challenge for healthcare systems. As a society, we collectively have an urgent need to find more effective avenues of identifying and treating individuals to save lives.
- Severe & Persistent Mental Health Conditions
Individuals with chronic and severe behavioral health diagnoses have ballooning healthcare costs as well. While anxiety and depression are the more prevalent behavioral health diagnoses, mental health conditions such as bipolar disorder and schizophrenia represent unique challenges for health plans and providers.8 Conditions such as these often result in complex, costly hospitalizations that are compounded when chronic disease and other physical health conditions are present.
Another costly aspect of the behavioral health conditions discussed is that they are rarely present without other comorbidities.2 While evidence-based treatments for depression, anxiety, and substance abuse are cost-effective long-term, a significant proportion of patients with these conditions also have other behavioral health or physical health conditions requiring additional assessment, diagnostic evaluations, and appropriate treatments. This can make it challenging to effectively manage patients’ full health needs.
To address these discrepancies in treatment care and cost, healthcare organizations must formulate a plan to prevent and successfully treat these issues. An integrated behavioral health strategy would create essential improvements in patient care and outcomes, and health plans would benefit simultaneously.
Disparities in Behavioral Health Treatment
Unfortunately, a lack of health equity means that patients are left without access to the care they need due to issues out of their control. Behavioral health disparities commonly affecting our communities include the inability to afford treatment costs, insurance inequities, lack of mental health access in general, and other socioeconomic factors such as not having access to transportation for provider visits.
Lack of Access
Patients can have insufficient access to treatment on many systematic levels.
- First, the shortage of healthcare providers means many places in the United States simply don’t have enough providers to see everyone who needs behavioral health services, particularly true of psychiatry and substance use disorder treatment. More than 112 million Americans currently live in areas without enough mental health providers to cover the population.9 And on a national level, this provider shortage is expected to continue at least through 2025.10
- Plus, insurance coverage for mental healthcare can be limiting, meaning patients without the finances to cover treatment may choose to go without care if they can’t afford it.11
- Finally, it’s hard to measure the quality of behavioral healthcare received; most behavioral health treatments are evidence-based, yet it’s difficult to quantify patients’ results of treatment. Therefore, while less than half of patients with mental health disorders are accessing care, we don’t know how many of those who are being treated have improved quality health outcomes.11
Reducing disparities in behavioral health is crucial for payers and providers. While there are significant issues with the healthcare system that cause the current disparities, all will benefit from reducing or eliminating them.
Streamlining Behavioral Health Programs
Addressing behavioral health can be as challenging for health plans as it is for the members they serve trying to access the behavioral health system of care. Upheaval from the global pandemic, ballooning costs of care, treatment disparities, and workforce challenges all contribute to patients doing without essential mental healthcare services.
That’s where Clearlink comes in. As a healthcare management consulting firm, we help organizations manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity across physical and behavioral health. We have expertise in:
- Behavioral health integration,
- Behavioral health service insourcing,
- Mental health parity,
- Behavioral care management strategy,
- Coordination of care,
- Emotional well-being,
- Substance use disorders,
- And more.
- Peterson-KFF Health System Tracker, “How does health spending in the U.S. compare to other countries?”
- Managed Healthcare Executive, “Three of the Most-Costly Mental Health Disorders”
- The White House, “Reducing the Economic Burden of Unmet Mental Health Needs”
- Fierce Healthcare, “Moody’s: Why focusing on behavioral health could give insurers a leg up on the competition”
- Harvard Medical School Primary Care Review, “Here’s Why Mental Healthcare Is So Unaffordable & How COVID-19 Might Help Change This”
- Fierce Healthcare, “Industry Voices—Health plans paying price for unaddressed behavioral health needs”
- KFF, “A Look at Strategies to Address Behavioral Health Workforce Shortages: Findings from a Survey of State Medicaid Programs”
- Business Insider, “The US spends at least $225 billion on mental illness each year in a broken system with no clear-cut solutions”
- CNBC, “What you need to know about the cost and accessibility of mental health care in America”
- The Commonwealth Fund, “Medicare’s Mental Health Coverage: How COVID-19 Highlights Gaps and Opportunities for Improvement”
- Health Affairs, “Behavioral Health: A Payer-Based Strategy For Improving Access And Quality During COVID-19 And Beyond”