Behavioral health encompasses individual and family well-being, as well as a wide range of conditions that differ in degree of intensity and impact. As with physical health, behavioral health affects patients in highly personal and unique ways. And both behavioral and physical health influence each other significantly to determine overall health.
New research released today by Evernorth, the health services division of The Cigna Group, shows that 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.
“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 health care costs.”
And the demand for providers only continues to grow. Evernorth’s analysis finds that the prevalence of behavioral health conditions grew by 4% from 2021 to 2022. The analysis, which looks at anonymized and aggregated claims data of 6 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 health care spend for the entire population.
Increase in Prevalence of Behavioral Conditions, 2021-2022
Behavioral health care often starts with the primary care physician
The care journey is highly personal. Understanding this allows for more personalized and precise navigation of care. Our research uncovers four key patient journeys based on their health utilization.
Willing Engagers: These are patients receiving treatment for a behavioral health condition from a behavioral health provider. Compared to the other journeys, there is an increased prevalence of high acuity conditions, such as suicidal ideation, self-harm, and severe depression.
“The Willing Engagers group teaches us a lot about the opportunities for actively engaging the three other personas we’ve uncovered in our analysis,” said Urvashi Patel, vice president of the Evernorth Research Institute. “We found that when patients have their second outpatient visit within 10 days of their first, they are two times more likely to have three or more outpatient visits. In addition, continued outpatient care can reduce medical spend by up to $2,565 per member per year, which emphasizes the importance in finding the right provider-to-patient match to persist in care.”
Self-Directed Seekers: These patients are currently seeking treatment for a behavioral health condition from a medical provider. Anxiety, depression, and ADHD are their most common diagnoses, and treatment mainly consists of medication prescribed by their primary care physician (PCP).
Complex Copers: These patients receive services primarily for a chronic physical health condition and have one or more co-occurring behavioral health conditions that surface multiple times. These patients tend to be older and live in areas with higher risk for unmet social determinants of health (SDOH) needs, indicating increased barriers to care. It is unclear how aware patients may be of their behavioral health conditions because, while a clinician finds them significant enough to record multiple diagnoses, these diagnoses often occur during times of medical need and may not be directly addressed with the patient.
Silent Sufferers: These patients receive treatment primarily for a physical health condition and their behavioral health condition surfaces just one time in a medical setting. These also include patients who have behavioral health needs but have not been diagnosed yet.
“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 health care.”
Medical conditions with co-occurring behavioral conditions
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 impacts workplaces, families, communities, and health care costs. In fact, costs for patients with a medical condition and behavioral condition are 2-3 times higher than for patients without a behavioral condition.
Risk-Adjusted Medical Costs by Comorbid Medical Condition
On the bright side, Evernorth data shows that effective behavioral health treatment (adherence to antidepressant medication and/or 3+ behavioral outpatient visits) can reduce this spend. For example, patients with type II diabetes and major depressive disorder (MDD) who receive behavioral treatment show a medical savings of $1,649 per member per year, compared to patients who receive insufficient behavioral care.
“The mind and body are intrinsically connected,” Borden added. “It’s something that plan sponsors must take into account. Employee mental health is being challenged like it never has been before, and this impacts the workplace. Companies that expand their definition of health and well-being in the workforce to encompass both physical and mental health, and are able to provide holistic support through benefits and employee well-being programs, stand to win in the end.”