Healthcare costs rise when physical symptoms of mental health conditions are underrecognized and the patient becomes a statistic. Human touch from an HMC HealthWorks™ advocate gets the patient engaged and forms a personal connection.
Medicine should be a personal experience because each patient is unique, and everyone has a medical and family history. However, while patients can easily access their medical records, get background information on physicians, and consult “Doctor Google” to learn more about their health, medicine often becomes a very impersonal practice. Patient care can then become secondary and the doctor-patient rapport can be lost.
It’s easy to feel like a number when accessing your health information. Logins require inputting a deliberately confusing combination of letters, numbers and symbols. Furthermore, a patient may be referred from physician to physician without confidently knowing whether the physicians are communicating throughout the process. With numerous healthcare plans or wellness programs in place, treatment can look very turn-key and impersonal.
It’s vital that patients feel confident, safe and supported by their entire healthcare team. Especially those patients who require a mental health program or suffer from a behavioral health condition. Too often, mental health conditions are undertreated, resulting in high costs for patients and the medical system. Concurrent, coordinated, and holistic treatment is the key to better outcomes.
Co-morbidity Costs Everyone More
Patients, their families, public/private health insurers and other stakeholders are all impacted by the rise in people living with multiple chronic conditions. This often leads to poorer health outcomes and an increase in healthcare utilization and associated healthcare costs.
There are several contributing factors that are driving comorbidity, including an aging population with improved access to detection and diagnosis of disease. However, lifestyle changes are also driving the onset of disease (such as diabetes or cardiovascular disease, whose contributing factors are associated with diet and a more sedentary lifestyle). Similarly, drug-to-disease and disease-to-disease interactions play a role, as do environmental factors (such as pollution). In their comprehensive report, the Robert Wood Johnson Foundation reported that these factors are interrelated. Medical illness can lead to mental or behavioral health disorders and vice versa.
Behavioral health can be remarkably expensive. In a report prepared for the American Psychiatric Association, Milliman Inc. found that, “Medical costs for treating those patients with chronic medical and comorbid mental health/substance use disorder (MH/SUD) conditions can be 2-3 times as high as those beneficiaries who don‘t have the comorbid MH/SUD conditions. The additional healthcare costs incurred by people with behavioral comorbidities are estimated to be $293 billion in 2012 across commercially-insured, Medicaid, and Medicare beneficiaries in the United States.”
As explained by the Centers for Disease Control and Prevention, the rise in healthcare utilization also impacts employers and employees. They report that, “most of the financial burden of mental health disorders is not from the cost to treat the illness. It is because of income loss from unemployment, expenses for social supports, and indirect costs—such as workers’ compensation, short-and long-term disability, presenteeism (the measurable extent to which health symptoms, conditions, and diseases adversely affect the work productivity of individuals who choose to remain at work) and absenteeism. Complications because of untreated chronic diseases and mental health disorders are the primary cause of missed work and increased presenteeism.”
Milliman asserts that there are savings (about 9-16 percent) to be had if there is greater integration between the treatment of behavioral and medical health services.
Mental | Behavioral Health Treatment in the United States Should be a Priority
The National Alliance on Mental Illness, NAMI, reports that 18.5 percent of adults in America – around 43.8 million people – struggle with mental illness each year. When faced with a serious mental illness, an adult is also more at risk for chronic medical conditions. It is estimated that more than 68 percent of adults with a mental disorder have at least one general medical disorder, and 29 percent of those with a medical disorder had a comorbid mental health condition.
For example, it’s incredibly common for those living with chronic conditions such as diabetes, heart disease, arthritis and cancer to develop depression. The American Hospital Association estimates that untreated depression combined with chronic illness can increase monthly healthcare costs per individual by, on average, $560.00. NAMI estimates that mental illness costs America $193.2 billion in lost earnings per year. Depression alone, in the United States, is a “leading cause of disability for people aged 15–44 years, resulting in almost 400 million disability days per year, substantially more than most other physical and mental conditions.” Sadly, people with mental illness are at risk for dying early, possible as much as 25 years earlier than others, despite many of their conditions being very treatable.
Importantly, some patients with behavioral treatment needs may not present with “mood” complaints. For example, patients with chest pain may seek medical advice, but fail to report that they also suffer from low or depressed thoughts which can be directly linked to the onset of such pain. This is an example of how mental illness can lead to physical illness but remain undertreated.
Proactively Addressing Behavioral Health Can Reduce Healthcare Costs and Improve Outcomes
The need for a human touch to guide healthcare becomes apparent when you consider other high costs of comorbid medical and mental health conditions beyond dollars and cents. Patients with multiple health concerns may more often be subject to social isolation, economic worries, and a variety of other problems that could lead to depression, anxiety, substance abuse and other behavioral disorders.
Physicians are onboard with treating this population. 94 percent agree that integrating behavioral care into medical care directly improves patient outcomes, particularly when they see their patients following through on seeking additional services following their referral. Furthermore, studies show that concurrent and coordinated treatment of medical and behavioral conditions is important to good outcomes. For example, one study showed that among diabetes patients with psychiatric disorders, those actively treated for their behavioral health conditions had favorable HbA(1c) levels. On the other hand, poor mental health is also associated with serious health complications such as heart disease, high blood pressure, weakened immune system, asthma, obesity, gastronomical problems and premature death.
As stated by NAMI, “The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have a significant reduction of symptoms and improved quality of life with the right treatments and supports.”
The Challenges of Accessing Collaborative and Human Driven Care Are Real
It’s been more than ten years since the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law, yet many people with behavioral health issues do not receive the care they require. By 2025, the National Council on Behavioral Health estimates that there will be 6,000-15,000 fewer psychiatrists than needed to treat people with mental and behavioral health issues in the United States. This same report pointed out that 55 percent of counties have no psychiatrists at all.
During a mental health or behavioral health crisis, many patients are triaged by an emergency physician or in a primary care clinic. However, data shows that of the 80 percent of those seeking behavioral care, 60-70 percent will leave without those symptoms being addressed. Part of the problem may lie with the shortage of medical professionals trained to support their presenting symptoms.
The impact of stigma cannot be ignored when considering barriers to treatment. Stigma or the fear of negative reactions or judgment from friends, families, colleagues, and society prevents people from seeking help because they aim to avoid taboo labels such as “crazy,” “ill,” or “unable to cope.” Beyond perception, stigma can become real when a diagnosis might lead to public discrimination. If one avoids seeking a new job or promotion because they are seeking medical treatment, then this outcome might want to be avoided by the person in need of treatment. The CDC reported that delaying treatment can have severe medical consequences on its own.
There are other barriers against care as well, ranging from how technology and privacy concerns prevent the integration of care to how behavioral health care providers and patients are reimbursed for provided and received services, respectively, compared to other kinds of treatment.
The Human Touch for Patient-Centered Care is Key
Given the complexities of the United States healthcare system and the numerous barriers to care, it’s easy to see how patients may feel lost seeking treatment for concurrent medical and behavioral health conditions. Yet, undertreating these conditions put patients at risk for complications and personal economic and social hardship, while simultaneously contributing to rising healthcare utilization and costs that impact all of us.
Physicians and mental health professionals are increasingly embracing a patient-centered approach that affords an increased opportunity for personalized care. However, for the patient to benefit, they may need better support to stay engaged with their treatment plan. A patient advocate, or someone assigned to help them navigate and successfully access their healthcare benefits, could be the solution. A navigator can coach and help prepare patients for medical appointments, assist in identifying specialists, making appointments and centralize the transfer of medical information.
Studies also show that patient navigators can not only facilitate improved healthcare access and quality for underserved populations through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in medical providers and the health system that often leads to avoidance of health problems and non-compliance with treatment recommendations. Patient navigators can foster trust and empowerment within the communities they serve.”
While MHPAEA made it illegal to discriminate or provide reduced services for those people with mental illness or behavioral health issues, many people remain undertreated. It’s time to educate patients and their support systems about the importance of treating their entire self and provide support to make the process seamless and timely.
Medicine should be personal because everyone has a unique medical and family history.
 Miller-Matero, LR, et al., National Center for Biotechnology Information, “Benefits of integrated behavioral health services: the physician perspective,” March 2016. Last accessed on 1/25/19 at https://www.ncbi.nlm.nih.gov/pubmed/26963777
 “I’m IN to Mental Health” National Association of Mental Illness. Last access on October 9, 2017 at https://www.nami.org/Get-Involved/Awareness-Events/Awareness-Messaging
 Saporito, JM, Ryan. C, Teachman, BA, “Reuding stigma toward seeking mental health treatment among adolescents,” Stigma Res Action. 2011; 1(2): 9–21. Published online 2011. Last access on October 9, 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839682/
 Shrivastava, A., Bureau, Y., Rewari, N., et. al. “Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification. Indian J Psychiatry. 2013 Apr-Jun; 55(2): 178–182.
doi: 10.4103/0019-5545.111459 Last access on October 9, 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696244/