Today, there is increasing recognition of the need to address social and behavioral determinants of health to improve outcomes. Yet for members with chronic conditions, a behavioral health approach to care management often is lacking—and that’s a missed opportunity to improve value and outcomes.
We know that members with behavioral health issues have higher-than-average rates of emergency department (ED) visits, hospitalizations and readmissions. That’s one reason why efforts to target high-risk populations with proactive, personalized care management have begun to include behavioral health components in recent years.
But for those with chronic conditions—not just the typical Core 5 conditions of coronary artery disease, chronic obstructive pulmonary disease, heart failure, diabetes and asthma—the approach to care management still is largely focused on condition-specific regimens. This simplistic approach to care management often fails to consider behavioral health issues that can interfere with members’ ability to comply with their treatment plans or that exacerbate their health conditions.
The result: members’ health status does not improve, leading to continued high utilization—including increased use of emergency care—and difficulties managing health effectively.
When we treat chronic conditions by focusing exclusively on the medical components of these conditions, we miss one-third of the contributing costs and contributing factors.
What is needed is an integrated approach to care management, one that seeks to incorporate behavioral health management into a comprehensive care plan based on the patient’s individual health needs.
The value of integrated care management
One-third of the conditions identified by the Institute of Medicine as having a significant impact on the nation’s economy are or include behavioral health disorders. Together, these nine conditions—arthritis, cancer survivorship, chronic pain, dementia, depression, type 2 diabetes, post-traumatic disabling conditions, schizophrenia, and vision and hearing loss—account for billions of dollars in healthcare spending annually. Understanding the ways in which behavioral health impacts physical health, particularly for members with chronic illness, is critical to achieving the Triple Aim: improving health outcomes, reducing costs, and boosting member satisfaction.
Here are four of the top benefits of incorporating behavioral health management into care management plans for members with chronic conditions.