Integrated behavioral health key to helping struggling employees

Are you a business owner or employer? Are you concerned about the health and functioning of your employees? Do you wish your company could save money by providing better health care for your staff?

Before the pandemic, analysts showed that 70% of our medical dollars were spent on 10% of patients. In an analysis of 2017 health care claims data of 21 million commercially insured patients, Milliman Research found “the annual total health care costs for individuals in that top 10% high-cost group averaged $41,631, which was 21 times the $1,965 average cost per individual in the other 90% of the population.”

They found that 57% of the high-cost group had behavioral health conditions, and their average annual cost was $45,862. The high-cost group with behavioral health conditions were only 5.7% of the total patient population yet they accounted for 44% of the total cost. The surprising and concerning finding was that the total spending on behavioral health treatment for half of these patients was less than $95 per year. It costs 2-6 times more to provide medical/surgical treatment to patients with behavioral health conditions, and more than half of them are not getting any behavioral health treatment.

Our current model of health care is extremely fragmented with the separation of care providers, systems and insurance reimbursement practices. Even before the pandemic, there was a shortage of mental health providers, long wait times, stigma and other barriers to care. Primary care providers have been the “de facto” mental health providers prescribing more than 75% of all psychotropic medications even though this is not their area of primary training.

Poor employee mental health also leads to other employer costs because of an increase in absenteeism, “presenteeism,” turnover and disability of employees. Employees with mental health conditions miss 6-25 more days per year with depressed employees’ work performance being impaired 20% of the time. Additionally, a Spring Health study found 70% of employed informal caregivers had to reduce work hours, find a less demanding job, turn down a promotion, take a leave of absence or retire early.”

Calling it the “Hidden Fourth Wave of the Pandemic,” the New York Times is one of the numerous news outlets publicizing the worsening mental health crisis. The virus itself has neurological effects on top of the major life disruptions from the pandemic without a clear end in sight. Even people without previous mental health problems are struggling because of the inability to utilize usual coping strategies that include travel, entertainment and participation in church and other social groups, the Times reported.

DIFFERENT MODELS EXIST
The good news is that there is a model of care that has been shown to save money, improve health outcomes, and make patients and doctors more satisfied with their care. Integrated behavioral health incorporates mental health services with physical health care. These findings were confirmed in a study by the Rand Corporation for the American Medical Association, but they found that optimal integration remains limited by cultural, financial and other factors.

The AMA’s vice president, Kathy Blake, MD, MPH, said this was a wake-up call leading the AMA to establish the Behavioral Health Integration (BHI) Collaborative, with seven other physician organizations, to overcome the obstacles to integrating behavioral and mental health care into primary care practices.”

Arkansas Behavioral Health Integration Network (ABHIN) is a nonprofit grassroots organization that was created to be part of the solution. ABHIN does not provide mental health treatment services, but its purpose is to provide training and support for medical providers in Arkansas to implement integrated behavioral health care into their practices.

Because behavioral health integration is a different type of practice than current traditional specialty mental health care, focused education, training and support is needed for both mental health providers and medical providers. ABHIN’s co-founders, Kim Shuler, LSCW, and me have more than 10 years of experience working in integrated behavioral practices and understand the complexity of such a radical change in medical practice.

There are many great services and committed people in Arkansas but there is a critical need to break down barriers. ABHIN’s goal is to build connections and relationships to be a bridge between medical providers and specialty mental health providers.

With two grants awarded in September, ABHIN is also working to reduce suicides and opioid use disorder in Arkansas by providing training for primary care clinics in suicide assessment and crisis response. The first training was recorded on October 23 and is available with several others on the website, www.ABHINetwork.org.

ABHIN plans to be part of the solution in improving patient care and outcomes, increasing patient and provider satisfaction, and providing support for family physicians. If you have ideas, suggestions or want to get involved, contact Kim Shuler, LCSW, at [email protected] or me at [email protected].

Editor’s note: Patty Gibson, MD is co-founder and Chief Medical Officer of Arkansas Behavioral Health Integration Network. A video interview on this subject is available below. The opinions expressed are those of the author.